Vuilleumier P, Jallon P
Unité d'Epileptologie Clinique et d'Electroencéphalographie, Hôpitaux Universitaires de Genève, Suisse.
Rev Neurol (Paris). 1998 May;154(4):305-17.
Data about psychiatric disorders associated with epilepsy as well as their risk factors are heterogeneous. The overall prevalence of psychiatric disturbances in epileptic patients can be estimated between 20 and 30 per cent. It is the highest in pharmocoresistant cases seen in specialized centers. Psychotic disorders, depression, and suicide are the three most common among interictal disturbances. Psychoses affect 2 to 9 per cent of patients and are more frequent in cases with aura or altered consciousness, such as in complex partial seizures and absences. They correlate positively with the multiplicity of seizures but often inversely with their frequency. Temporal lobe epilepsy is associated with schizo phrenic-like and paranoid types of psychosis, but frontal lobe epilepsy is also common. A putative association with predominant left or bilateral EEG abnormalities in cases with partial epilepsy remains to be confirmed, as well as the frequency of underlying structural lesions. Depressive disorders affect 20 to 60 per cent of patients. While their occurrence with partial complex seizures and left hemisphere foci is common, the role of temporal lobe involvement still appears controversial. Depression prevails in cases with seizures that occasionally, albeit rarely, secondarily generalize and correlates with the duration of the disease, intractable seizures, and polypharmacy. A genetic factor is likely to play a role. Suicides rates are increased, encountered in 0.2-0.5 per cent of patients and causing deaths in 3-7 per cent of them. The overall risk might be the highest during the first years after diagnosis of epilepsy, as well as in patients with temporal lobe foci, depression, or psychosis. Great variability and discordance in results show the major difficulties encountered in epidemiologic studies. Most of these problems relate to the classification of epileptic disorders as well as that of psychiatric disorders, the variability in the methods and measures which are used, and frequent bias in the selection of patients. We review here data about the frequency of major psychiatric disorders in epileptic patients or the frequency of epileptic disorders in psychiatric patients, and also possible risk factors related to the epileptic disease and its evolution.
与癫痫相关的精神障碍及其危险因素的数据参差不齐。癫痫患者中精神障碍的总体患病率估计在20%至30%之间。在专科中心所见的药物难治性病例中患病率最高。精神病性障碍、抑郁症和自杀是发作间期障碍中最常见的三种。精神病影响2%至9%的患者，在有先兆或意识改变的病例中更常见，如复杂部分性发作和失神发作。它们与发作的多样性呈正相关，但通常与发作频率呈负相关。颞叶癫痫与精神分裂症样和偏执型精神病有关，但额叶癫痫也很常见。部分癫痫病例中与主要为左侧或双侧脑电图异常的假定关联以及潜在结构性病变的频率仍有待证实。抑郁症影响20%至60%的患者。虽然它们在部分复杂性发作和左侧半球病灶患者中很常见，但颞叶受累的作用仍存在争议。抑郁症在偶尔（尽管很少）继发全面性发作的癫痫病例中占主导，并且与疾病持续时间、难治性发作和联合用药相关。遗传因素可能起作用。自杀率升高，见于0.2%至0.5%的患者，其中3%至7%的患者死亡。总体风险在癫痫诊断后的头几年以及有颞叶病灶、抑郁症或精神病的患者中可能最高。结果的巨大变异性和不一致性表明了流行病学研究中遇到的主要困难。这些问题大多与癫痫障碍以及精神障碍的分类、所使用方法和测量的变异性以及患者选择中频繁出现的偏差有关。我们在此回顾癫痫患者中主要精神障碍的发生率或精神科患者中癫痫障碍的发生率，以及与癫痫疾病及其演变相关的可能危险因素。
