Krahn L E, Rummans T A, Peterson G C
Department of Psychiatry and Psychology, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1996 Dec;71(12):1201-4. doi: 10.4065/71.12.1201.
Clinicians must consider the psychiatric issues relevant to patients undergoing neurosurgical procedures for epilepsy. Obtaining the patient's psychiatric history can facilitate stabilizing the patient's condition before operative intervention. Preoperatively, depressive and anxiety disorders are the most common psychiatric conditions diagnosed in candidates for surgical treatment of epilepsy. Although psychotic disorders occur infrequently, they demand attention because symptoms may interfere with patient compliance with follow-up care. Patients with chronic psychotic symptoms who have ongoing seizures postoperatively and bilateral seizure foci are at higher risk for a poor outcome and postoperative psychosis. When psychiatric disorders are present, surgical management is not contraindicated, but preoperative psychiatric intervention may be warranted. Most patients have a favorable outcome with the elimination of seizures, which simplifies the subsequent treatment of a psychiatric disorder.
临床医生必须考虑与接受癫痫神经外科手术患者相关的精神问题。获取患者的精神病史有助于在手术干预前稳定患者病情。术前，抑郁和焦虑症是癫痫手术治疗候选者中最常见的精神疾病诊断类型。虽然精神障碍很少见，但因其症状可能干扰患者对后续治疗的依从性，所以需要关注。术后仍有癫痫发作且存在双侧癫痫病灶的慢性精神病症状患者预后不良及发生术后精神病的风险更高。当存在精神障碍时，手术治疗并非禁忌，但术前进行精神干预可能是必要的。大多数患者通过消除癫痫发作可获得良好预后，这简化了后续精神障碍的治疗。
