From the Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense; Danish Epilepsy Centre (G.R.), Dianalund; and Institute of Clinical Medicine (G.R.), University of Copenhagen, Denmark.
Neurology. 2024 Oct 22;103(8):e209921. doi: 10.1212/WNL.0000000000209921. Epub 2024 Sep 16.
Idiopathic generalized epilepsy (IGE) is associated with distinct behavioral traits, symptoms of frontal lobe dysfunction, and psychiatric comorbidity. Whether psychiatric symptoms are part of the IGE endophenotype or secondary to the burden of chronic disease is unknown. In this study, we aimed at describing the sequence of appearance of psychiatric and epilepsy symptoms in patients with IGE.
Inclusion criteria for this cohort study were diagnosis of IGE with age at diagnosis at 10-25 years. We created 2 mutually exclusive cohorts, 1 based on codes in Danish registers with a first IGE diagnosis from January 1, 2005, to December 31, 2018, and a second patient cohort treated at Odense University Hospital and the Danish Epilepsy Centre in the same period. Each case was matched with 10 age-matched, sex-matched, and geography-matched normal population controls from the Danish registers. We compared social status, health care utilization, and psychiatric diagnoses between the groups in the 5 years preceding epilepsy diagnosis, at diagnosis, and at the end of the study period using the Wilcoxon rank-sum test and confirmatory logistic regression models.
We identified 1,009 patients for the register-based cohort (55.1% female; mean age at diagnosis [SD]: 15.9 [±3.8] years) and 402 patients for the hospital-based cohort (56.2% female; mean age at diagnosis [SD]: 18.3 [±7.4] years) and matched them to 10,090 and 4,020 controls, respectively. IGE cohorts and controls did not differ at birth. In the 5 years before their IGE diagnosis, register patients had an increasing number of contacts with hospitals (mean visits [SD]: cases: 8.3 [±5.6], controls: 6.6 [±4.5]) and their general practitioners (mean visits [SD]: cases: 48.7 [±26.3], controls: 45.3 [±24.5]) and received more prescriptions for psychiatric medications (prescriptions: cases: 4.2%, controls: 2.5%, = 0.003) compared with controls. Patients had a higher rate of psychiatric comorbidity (comorbidity: cases: 26.5%, controls: 17.8%, < 0.0001) at the end of the study than controls. Data were similar in the hospital-based cohort.
Our data suggest a prodromal phase of IGE detectable approximately 5 years before the first seizure characterized by increased health care utilization and greater use of prescription medicine for psychiatric symptoms.
特发性全面性癫痫（IGE）与特定的行为特征、额叶功能障碍症状和精神共病有关。精神症状是否是 IGE 表型的一部分，还是慢性疾病负担的结果，尚不清楚。在这项研究中，我们旨在描述 IGE 患者精神和癫痫症状的出现顺序。
本队列研究的纳入标准为年龄在 10-25 岁之间的 IGE 诊断。我们创建了两个相互排斥的队列，一个基于丹麦登记处的代码，第一个 IGE 诊断为 2005 年 1 月 1 日至 2018 年 12 月 31 日，另一个患者队列在奥胡斯大学医院和丹麦癫痫中心治疗，时间相同。每个病例都与丹麦登记处的 10 名年龄匹配、性别匹配和地理匹配的正常人群对照相匹配。我们使用 Wilcoxon 秩和检验和验证性逻辑回归模型比较了两组在癫痫诊断前 5 年、诊断时和研究期末的社会地位、医疗保健利用和精神诊断。
我们在基于登记处的队列中确定了 1009 名患者（55.1%为女性；平均诊断年龄[SD]：15.9[±3.8]岁）和 402 名在医院接受治疗的患者（56.2%为女性；平均诊断年龄[SD]：18.3[±7.4]岁），并分别将其与 10090 名和 4020 名对照相匹配。IGE 队列和对照组在出生时没有差异。在他们 IGE 诊断前的 5 年中，登记患者与医院（平均就诊次数[SD]：病例：8.3[±5.6]，对照：6.6[±4.5]）和他们的全科医生（平均就诊次数[SD]：病例：48.7[±26.3]，对照：45.3[±24.5]）的接触次数增加，并且接受了更多的精神药物处方（处方：病例：4.2%，对照：2.5%，<0.0001）。与对照组相比，患者在研究结束时的精神共病率（共病：病例：26.5%，对照：17.8%，<0.0001）更高。基于医院的队列中的数据相似。
我们的数据表明，在首次癫痫发作前大约 5 年，可以检测到 IGE 的前驱期，其特征是医疗保健利用增加和用于治疗精神症状的处方药物增加。
