Blumer D, Wakhlu S, Davies K, Hermann B
Department of Psychiatry, University of Tennessee, and Epi-Care Center, Memphis 38103, USA.
Epilepsia. 1998 May;39(5):478-86. doi: 10.1111/j.1528-1157.1998.tb01409.x.
To determine the incidence of psychiatric disorders before and after surgical treatment for partial epilepsy and to document the effectiveness of their treatment.
Fifty consecutive patients treated surgically for focal epilepsy (44 temporal and six frontal) were evaluated by established neuropsychiatric methods before surgery and over a mean period of 2 years after surgery. The patients with interictal dysphoric disorders, with or without psychotic episodes, were treated with tricyclic antidepressant medication alone or combined with serotonin selective reuptake inhibitors and, if necessary, with the addition of risperidone.
Before surgery, 25 (57%) of the 44 patients with temporal lobe epilepsy had dysphoric disorders. After surgery, 17 (39%) of the 44 patients experienced either de novo psychiatric complications (six psychotic episodes, six dysphoric disorders, and two depressive episodes) or exacerbation of preoperative dysphoric disorder (three patients). Eight previously intact patients of the 19 (42%) developed dysphoric disorders after surgery that were significantly related to recurrence of seizures. All psychiatric complications occurred in the first 2 months after surgery, except for the six patients intact before surgery, who had a recurrence of seizures. A significant predictor of ultimate excellent psychiatric outcome was complete absence of seizures after surgery. All postoperative psychiatric complications remitted on treatment with psychotropic medication in the compliant patients.
An exceptional psychiatric morbidity is associated with the months after temporal lobectomy. Possible pathogenetic mechanisms are discussed. Antidepressant drugs are very effective in treating the psychiatric disorders of chronic epilepsy; their use in conjunction with the surgical treatment of epilepsy appears to be crucial for the overall positive outcome of a significant number of patients.
确定部分性癫痫手术治疗前后精神障碍的发生率，并记录其治疗效果。
采用既定的神经精神病学方法，对50例连续接受手术治疗的局灶性癫痫患者（44例颞叶癫痫和6例额叶癫痫）在手术前及术后平均2年的时间里进行评估。对有发作间期烦躁症的患者，无论有无精神病发作，单独使用三环类抗抑郁药物治疗，或与5-羟色胺选择性再摄取抑制剂联合使用，必要时加用利培酮。
在44例颞叶癫痫患者中，25例（57%）在手术前有烦躁症。术后，44例患者中有17例（39%）出现了新发的精神并发症（6例精神病发作、6例烦躁症和2例抑郁发作）或术前烦躁症加重（3例患者）。19例（42%）术前无精神障碍的患者中有8例在术后出现了烦躁症，且与癫痫复发显著相关。除6例术前无精神障碍且有癫痫复发的患者外，所有精神并发症均发生在术后的前2个月。术后癫痫完全无发作是最终精神状态极佳的一个重要预测指标。在依从性好的患者中，所有术后精神并发症经精神药物治疗后均得到缓解。
颞叶切除术后数月会出现异常的精神发病率。文中讨论了可能存在的发病机制。抗抑郁药物在治疗慢性癫痫的精神障碍方面非常有效；在癫痫手术治疗中联合使用抗抑郁药物，对大量患者的整体良好预后似乎至关重要。
