Perini G I, Tosin C, Carraro C, Bernasconi G, Canevini M P, Canger R, Pellegrini A, Testa G
Department of Neurological and Psychiatric Sciences, University of Padova, Italy.
J Neurol Neurosurg Psychiatry. 1996 Dec;61(6):601-5. doi: 10.1136/jnnp.61.6.601.
Mood disorders have been described as the commonest psychiatric disorders in patients with temporal lobe epilepsy. Secondary depression in temporal lobe epilepsy could be interpreted either as an adjustment reaction to a chronic disease or as a limbic dysfunction. To clarify this issue, a controlled study of psychiatric disorders was conducted in different forms of epileptic and non-epileptic chronic conditions.
Twenty outpatients with temporal lobe epilepsy, 18 outpatients with juvenile myoclonic epilepsy--a primary generalised seizure disorder--20 matched type I diabetic patients, and 20 matched normal controls were assessed by a structured interview (SADS) and by self rating scales (Beck depression inventory (BDI) and the state and trait anxiety scales STAIX1 and STAIX2).
Sixteen (80%) patients with temporal lobe epilepsy fulfilled the criteria for a psychiatric diagnosis at the SADS interview with a significantly higher frequency than patients with juvenile myoclonic epilepsy (22%) and diabetic patients (10%) (P < 0.0001). The most frequent disorder in temporal lobe epilepsy was a mood disorder: 11 (55%) patients with temporal lobe epilepsy had depression compared with three patients with juvenile myoclonic epilepsy and two diabetic patients (P < 0.001). Eight patients with temporal lobe epilepsy with an affective disorder also had a comorbid personality or anxiety disorder. Patients with temporal lobe epilepsy scored significantly higher on BDI, STAIX1, and STAIX2 than the three control groups (P < 0.001, P < 0.01, P < 0.001).
Patients with temporal lobe epilepsy have a higher incidence of affective and personality disorders, often in comorbidity, than patients with juvenile myoclonic epilepsy and diabetic patients suggesting that these psychiatric disorders are not an adjustment reaction to a chronic disease but rather reflect a limbic dysfunction.
情绪障碍被认为是颞叶癫痫患者中最常见的精神疾病。颞叶癫痫继发的抑郁既可以被解释为对慢性疾病的适应性反应，也可以被解释为边缘系统功能障碍。为了阐明这个问题，针对不同形式的癫痫和非癫痫慢性疾病进行了一项精神疾病对照研究。
通过结构化访谈（情感障碍和精神分裂症日程表（SADS））以及自评量表（贝克抑郁量表（BDI）和状态与特质焦虑量表STAIX1及STAIX2）对20例颞叶癫痫门诊患者、18例青少年肌阵挛性癫痫门诊患者（一种原发性全身性癫痫障碍）、20例匹配的I型糖尿病患者以及20例匹配的正常对照进行评估。
在SADS访谈中，16例（80%）颞叶癫痫患者符合精神疾病诊断标准，其频率显著高于青少年肌阵挛性癫痫患者（22%）和糖尿病患者（10%）（P < 0.0001）。颞叶癫痫中最常见的疾病是情绪障碍：11例（55%）颞叶癫痫患者患有抑郁症，相比之下青少年肌阵挛性癫痫患者有3例，糖尿病患者有2例（P < 0.001）。8例患有情感障碍的颞叶癫痫患者还合并有人格或焦虑障碍。颞叶癫痫患者在BDI、STAIX1和STAIX2上得分显著高于三个对照组（P < 0.001，P < 0.01，P < 0.001）。
与青少年肌阵挛性癫痫患者和糖尿病患者相比，颞叶癫痫患者情感和人格障碍的发生率更高，且常合并存在，这表明这些精神疾病并非对慢性疾病的适应性反应，而是反映了边缘系统功能障碍。
