Kanner Andres M, Shankar Rohit, Margraf Nils G, Schmitz Bettina, Ben-Menachem Elinor, Sander Josemir W
Epilepsy Division and Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA.
University of Plymouth Peninsula School of Medicine, Truro, UK.
Ann Gen Psychiatry. 2024 Mar 4;23(1):11. doi: 10.1186/s12991-024-00493-2.
Epilepsy is one of the most common neurologic conditions. Its clinical manifestations are not restricted to seizures but often include cognitive disturbances and psychiatric disorders. Prospective population-based studies have shown that people with epilepsy have an increased risk of developing mood disorders, and people with a primary mood disorder have an increased risk of developing epilepsy. The existence of common pathogenic mechanisms in epilepsy and mood disorders may explain the bidirectional relation between these two conditions. Recognition of a personal and family psychiatric history at the time of evaluation of people for a seizure disorder is critical in the selection of antiseizure medications: those with mood-stabilizing properties (e.g., lamotrigine, oxcarbazepine) should be favoured as a first option in those with a positive history while those with negative psychotropic properties (e.g., levetiracetam, topiramate) avoided. While mood disorders may be clinically identical in people with epilepsy, they often present with atypical manifestations that do not meet ICD or DSM diagnostic criteria. Failure to treat mood disorders in epilepsy may have a negative impact, increasing suicide risk and iatrogenic effects of antiseizure medications and worsening quality of life. Treating mood disorders in epilepsy is identical to those with primary mood disorders. Yet, there is a common misconception that antidepressants have proconvulsant properties. Most antidepressants are safe when prescribed at therapeutic doses. The incidence of seizures is lower in people randomized to antidepressants than placebo in multicenter randomized placebo-controlled trials of people treated for a primary mood disorder. Thus, there is no excuse not to prescribe antidepressant medications to people with epilepsy.
癫痫是最常见的神经系统疾病之一。其临床表现不仅限于癫痫发作，还常常包括认知障碍和精神疾病。基于人群的前瞻性研究表明，癫痫患者患情绪障碍的风险增加，而原发性情绪障碍患者患癫痫的风险也增加。癫痫和情绪障碍中存在共同的致病机制，这可能解释了这两种疾病之间的双向关系。在评估癫痫患者时识别个人和家族精神病史，对于选择抗癫痫药物至关重要：对于有阳性病史的患者，应优先选择具有情绪稳定特性的药物（如拉莫三嗪、奥卡西平）作为首选，而应避免使用具有精神otropic不良特性的药物（如左乙拉西坦、托吡酯）。虽然癫痫患者的情绪障碍在临床上可能与其他人相同，但它们通常表现出不符合ICD或DSM诊断标准的非典型表现。癫痫患者的情绪障碍若不治疗可能会产生负面影响，增加自杀风险、抗癫痫药物的医源性效应并恶化生活质量。癫痫患者情绪障碍的治疗与原发性情绪障碍患者相同。然而，有一种常见的误解认为抗抑郁药具有促惊厥特性。大多数抗抑郁药在治疗剂量下使用是安全的。在多中心随机安慰剂对照试验中，接受原发性情绪障碍治疗的患者中，随机接受抗抑郁药治疗的患者癫痫发作的发生率低于接受安慰剂治疗的患者。因此，没有理由不给癫痫患者开抗抑郁药。
