Umbricht D, Degreef G, Barr W B, Lieberman J A, Pollack S, Schaul N
Psychiatric Research Department, Hillside Hospital, Glen Oaks, NY 11004.
Am J Psychiatry. 1995 Feb;152(2):224-31. doi: 10.1176/ajp.152.2.224.
This study sought to elucidate the relation of clinical, neuropsychological, and seizure variables to chronic and postictal psychoses in patients with temporal lobe epilepsy.
Forty-four patients with treatment-refractory temporal lobe epilepsy were given formal psychiatric evaluations; 29 patients had no psychiatric disorder or a nonpsychotic disorder, eight patients had postictal psychoses, and seven patients had chronic psychoses. Comparisons of clinical, neuropsychological, magnetic resonance imaging, and seizure variables were made between the nonpsychotic and the psychotic patients and, secondarily, between the patients with transient postictal psychoses and those with chronic psychoses.
Bitemporal seizure foci, clustering of seizures, and absence of febrile convulsions were associated with both postictal psychoses and chronic psychoses. Younger age at onset of epilepsy and lower verbal and full-scale IQs differentiated the patients with chronic psychoses from those with postictal psychoses.
Patients with temporal lobe epilepsy with chronic and postictal psychoses show similar profiles of clinical and seizure variables, suggesting shared etiologic factors. These factors may increase the propensity to develop psychotic symptoms, while other factors, such as time of onset of epilepsy and underlying neuropathology, may determine whether transient or chronic psychotic symptoms develop. Even among patients with treatment-refractory temporal lobe epilepsy, a specific subgroup of patients, characterized by bitemporal seizure foci, an absence of febrile convulsions, and a history of clustering of seizures, appears to be particularly prone to develop psychotic disorders. A process similar to secondary epileptogenesis may be involved in the development of the psychoses.
本研究旨在阐明临床、神经心理学和癫痫发作变量与颞叶癫痫患者慢性和发作后精神病之间的关系。
对44例难治性颞叶癫痫患者进行了正式的精神病学评估；29例患者无精神障碍或非精神病性障碍，8例患者有发作后精神病，7例患者有慢性精神病。对非精神病患者和精神病患者之间，以及其次对短暂发作后精神病患者和慢性精神病患者之间的临床、神经心理学、磁共振成像和癫痫发作变量进行了比较。
双侧颞叶癫痫病灶、癫痫发作成簇以及无热性惊厥与发作后精神病和慢性精神病均相关。癫痫发病年龄较小以及语言和全量表智商较低可将慢性精神病患者与发作后精神病患者区分开来。
患有慢性和发作后精神病的颞叶癫痫患者表现出相似的临床和癫痫发作变量特征，提示存在共同的病因因素。这些因素可能增加出现精神病症状的倾向，而其他因素，如癫痫发病时间和潜在的神经病理学，可能决定是出现短暂性还是慢性精神病症状。即使在难治性颞叶癫痫患者中，一个以双侧颞叶癫痫病灶、无热性惊厥和癫痫发作成簇病史为特征的特定亚组患者似乎特别容易发生精神障碍。精神病的发生可能涉及一个类似于继发性癫痫发生的过程。
