Peltola Jukka, Surges Rainer, Voges Berthold, von Oertzen Tim J
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Neurology, Tampere University Hospital, Tampere, Finland.
Epilepsia Open. 2024 Feb;9(1):15-32. doi: 10.1002/epi4.12851. Epub 2023 Nov 27.
Apart from seizure freedom, the presence of comorbidities related to neurological, cardiovascular, or psychiatric disorders is the largest determinant of a reduced health-related quality of life in people with epilepsy (PwE). However, comorbidities are often underrecognized and undertreated, and clinical management of comorbid conditions can be challenging. The focus of a comprehensive treatment regimen should maximize seizure control while optimizing clinical management of treatable comorbidities to improve a person's quality of life and overall health. A panel of four European epileptologists with expertise in their respective fields of epilepsy-related comorbidities combined the latest available scientific evidence with clinical expertise and collaborated to provide consensus practical advice to improve the identification and management of comorbidities in PwE. This review provides a critical evaluation for the diagnosis and management of sleep-wake disorders, cardiovascular diseases, cognitive dysfunction, and depression in PwE. Whenever possible, clinical data have been provided. The PubMed database was the main search source for the literature review. The deleterious pathophysiological processes underlying neurological, cardiovascular, or psychiatric comorbidities in PwE interact with the processes responsible for generating seizures to increase cerebral and physiological dysfunction. This can increase the likelihood of developing drug-resistant epilepsy; therefore, early identification of comorbidities and intervention is imperative. The practical evidence-based advice presented in this article may help clinical neurologists and other specialist physicians responsible for the care and management of PwE.
除了无癫痫发作外，与神经、心血管或精神疾病相关的合并症是癫痫患者（PwE）健康相关生活质量下降的最大决定因素。然而，合并症往往未得到充分认识和治疗，合并症的临床管理可能具有挑战性。综合治疗方案的重点应是最大限度地控制癫痫发作，同时优化可治疗合并症的临床管理，以提高患者的生活质量和整体健康水平。一个由四位在各自癫痫相关合并症领域具有专业知识的欧洲癫痫专家组成的小组，将最新的科学证据与临床专业知识相结合，并合作提供共识性实用建议，以改善PwE合并症的识别和管理。本综述对PwE的睡眠-觉醒障碍、心血管疾病、认知功能障碍和抑郁症的诊断和管理进行了批判性评估。只要有可能，都提供了临床数据。PubMed数据库是文献综述的主要搜索来源。PwE中神经、心血管或精神合并症潜在的有害病理生理过程与引发癫痫的过程相互作用，以增加大脑和生理功能障碍。这可能会增加发展为药物难治性癫痫的可能性；因此，早期识别合并症并进行干预势在必行。本文提出的基于实践证据的建议可能会对负责PwE护理和管理的临床神经科医生和其他专科医生有所帮助。
