From the Departments of Neurology (C.-S.K.), Epidemiology (C.-S.K.), and Neurosurgery (C.-S.K.), Columbia University Irving Medical Center, New York; the Gertrude H. Sergievsky Center (C.-S.K.), New York, NY; School of Medicine (A.R.), Iran University of Medical Sciences, Tehran, Iran; Department of Psychiatry (C.-S.K., C.R.N.), University of Oxford, United Kingdom; School of Psychological Sciences (M.G., A.S.), Macquarie University, Sydney, Australia; and Department of Neurology (N.J.), University of Calgary, Alberta, Canada.
Neurology. 2024 Aug 13;103(3):e209622. doi: 10.1212/WNL.0000000000209622. Epub 2024 Jul 15.
Persons with epilepsy (PwE) have a higher risk of developing psychiatric comorbidities compared with the general population. There is limited knowledge about the prevalence of multiple psychiatric conditions in PwE. We summarize the current evidence on the prevalence of multipsychiatric comorbidities in PwE compared with persons without epilepsy.
A systematic review of multipsychiatric comorbidities in PwE compared with persons without epilepsy was performed, and the results were reported using the Preferred Reporting Items of Systematic Reviews and Meta-analyses reporting standards. The search was conducted from January 1945 to June 2023 in Ovid MEDLINE. Embase, and PsycINFO, using the search terms related to "epilepsy," "psychiatric comorbidity," and "multimorbidity," combined with psychiatric disorders. Abstracts were reviewed in duplicate, and data were independently extracted using standard proforma. Data describing multipsychiatric comorbidities in PwE compared with persons without epilepsy were recorded. Descriptive statistics and, when feasible, meta-analyses are presented. The risk of bias of the studies was assessed using the Newcastle-Ottawa Scale and the International League Against Epilepsy tool.
A total of 12,841 records were identified from the systematic database search, and 15 studies met the eligibility criteria. All included studies were deemed high-quality in risk of bias according to both tools. The prevalence of multipsychiatric comorbidity was greater in persons with compared with those without epilepsy. The pooled prevalence of concomitant depression and anxiety disorder in PwE in 2 population-based studies was 15 of 163 (9.2%), which was significantly higher than 250 of 10,551 (2.4%) in patients without epilepsy (odds ratio [OR] 3.7, 95% CI 2.1-6.5, -value <0.001, = 0%, Cochran -value for heterogeneity = 0.84). In 2 hospital-based studies, the prevalence of concomitant depression and attention-deficit/hyperactivity disorder in PwE (14/97, 14.4%) was significantly higher than in patients without epilepsy (5/126, 3.9%), with an OR 5.2 (95% CI 1.8-15.0, -value = 0.002, = 0%, Cochran -value for heterogeneity = 0.79).
PwE experience elevated levels of multipsychiatric comorbidity compared with those without epilepsy. However, very few studies have empirically evaluated the extent of multipsychiatric comorbidity in PwE compared with persons without epilepsy nor their associations and consequences to prognosis in PwE.
与普通人群相比，癫痫患者（PwE）出现精神共病的风险更高。目前对于 PwE 多种精神共病的患病率知之甚少。我们总结了目前关于 PwE 与非癫痫患者相比多种精神共病患病率的证据。
对 PwE 与非癫痫患者的多种精神共病进行了系统评价，并使用系统评价和荟萃分析首选报告项目的报告标准报告结果。从 1945 年 1 月至 2023 年 6 月，在 Ovid MEDLINE、Embase 和 PsycINFO 中，使用与“癫痫”、“精神共病”和“多种疾病”相关的搜索词，结合精神障碍进行了搜索。对摘要进行了双人审查，并使用标准表格独立提取数据。记录了 PwE 与非癫痫患者相比多种精神共病的数据。描述性统计和可行时的荟萃分析。使用纽卡斯尔-渥太华量表和国际抗癫痫联盟工具评估研究的偏倚风险。
从系统数据库搜索中总共确定了 12841 条记录，符合入选标准的研究共有 15 项。根据这两种工具，所有纳入的研究在偏倚风险方面均被认为是高质量的。与无癫痫患者相比，有癫痫患者的多种精神共病患病率更高。在 2 项基于人群的研究中，PwE 中同时患有抑郁和焦虑障碍的患病率为 163 例中的 15 例（9.2%），显著高于 10551 例患者中的 250 例（2.4%）（比值比 [OR] 3.7，95%置信区间 2.1-6.5，-值 <0.001， = 0%，Cochran 异质性 -值 = 0.84）。在 2 项基于医院的研究中，PwE 中同时患有抑郁和注意力缺陷/多动障碍的患病率（97 例中的 14 例，14.4%）明显高于无癫痫患者（126 例中的 5 例，3.9%），比值比为 5.2（95%置信区间 1.8-15.0，-值 = 0.002， = 0%，Cochran 异质性 -值 = 0.79）。
与无癫痫患者相比，PwE 经历更高水平的多种精神共病。然而，很少有研究实证评估 PwE 与非癫痫患者相比多种精神共病的程度，也没有评估它们之间的关联及其对 PwE 预后的影响。
