癫合并焦虑

近年来人们日益认识到癫(Ep)合并情感性精神障碍的重要性,但多数研究集中干抑郁症。然而,Ep伴发焦虑障碍十分普遍,文献报道焦虑障碍的患病率达111%~46%。有研究表明,Ep和焦虑具有双向联系,且可能有共同的病理生理基础。焦虑严重影响Ep患者的生活质量,放大抗癫药物的不良反应。尽管如此,临床上常忽略对焦虑症状的筛查。Ep患者的焦虑症状可分为仅出现于Ep发作前、中和后(围Ep发作期)的焦虑,类似原发性焦虑障碍的焦虑症,或与Ep本身或其治疗有关的焦虑。对Ep焦虑症状的治疗包括:更有效的控制Ep发作治疗围Ep发作期的焦虑,而大多数形式的焦虑发作以认知行为治疗或药物治疗为主。     

Depression and Anxiety in People with Epilepsy

Many recent epidemiological studies have found the prevalence of depression and anxiety to be higher in people with epilepsy (PWE) than in people without epilepsy. Furthermore, people with depression or anxiety have been more likely to suffer from epilepsy than those without depression or anxiety. Almost one-third of PWE suffer from depression and anxiety, which is similar to the prevalence of drug-refractory epilepsy. Various brain areas, including the frontal, temporal, and limbic regions, are associated with the biological pathogenesis of depression in PWE. It has been suggested that structural abnormalities, monoamine pathways, cerebral glucose metabolism, the hypothalamic-pituitary-adrenal axis, and interleukin-1b are associated with the pathogenesis of depression in PWE. The amygdala and the hippocampus are important anatomical structures related to anxiety, and γ-aminobutyric acid and serotonin are associated with its pathogenesis. Depression and anxiety may lead to suicidal ideation or attempts and feelings of stigmatization. These experiences are also likely to increase the adverse effects associated with antiepileptic drugs and have been related to poor responses to pharmacological and surgical treatments. Ultimately, the quality of life is likely to be worse in PWE with depression and anxiety than in PWE without these disorders, which makes the early detection and appropriate management of depression and anxiety in PWE indispensable. Simple screening instruments may be helpful for in this regard, particularly in busy epilepsy clinics. Although both medical and psychobehavioral therapies may ameliorate these conditions, randomized controlled trials are needed to confirm that.     

How Common Is Catamenial Epilepsy?

Forty women of childbearing age with refractory epilepsy were asked to record their seizures, the first and last days of their menstrual periods, and symptoms of premenstrual tension for 3 consecutive months. By defining catamenial epilepsy as the occurrence of at least 75% of seizures each month in the 10-day time frame, which included the 4 days preceding menstruation and the 6 days after its onset, only 5 women (12.5%) were identified who fulfilled the criterion. Nevertheless, after the study was completed, 31 (78%) of these patients claimed that most of their seizures occurred near the time of and were exacerbated by menstruation. The patients with catamenial epilepsy reported no more symptoms of premenstrual tension than did the rest of the group. Clustering outside the menstrual cycle was noted in 4 other patients. Catamenial epilepsy is an uncommon condition. Patient claims about frequency of seizures in relation to menstruation are not always accurate. A standard definition should be adopted because the diagnosis has implications for management.     

Elderly People and Epilepsy: Cognitive Function

Summary:  Purpose: To evaluate cognitive function in a group of elderly patients with focal epilepsy versus healthy controls.
Methods: A neuropsychological battery assessing major cognitive domains was administered to 40 patients with focal epilepsy aged ≥60 years, and to 40 controls matched for sex, age, and education.
Results: Epilepsy patients performed significantly worse in most of the administered tests than controls (p < 0.05). Poor cognitive performances correlated with use of polytherapy.
Conclusions: Given the high prevalence of epilepsy in the elderly, our results could have important implications for clinical and research purposes.     

Overview and Perspectives of Employment in People with Epilepsy

Summary:  Even though it is now the viewpoint of the majority of professionals working in epilepsy care that most people with epilepsy should and can perform on the labor market as does anybody else, research tells a different story. Most figures concerning employment rates of people with epilepsy indicate that they do not perform as well on the labor market as others do. Although both research figures and research groups vary, generally unemployment rates are higher for people with epilepsy than for the general population. Early studies showed that the situation for people with epilepsy was rather grim. Later studies showed similar outcomes. Unemployment rates vary between groups and countries. Research shows that being employed is an important ingredient of the quality of life of people with epilepsy. The World Health Organization also recognizes the importance of employment as a part of social health, and therefore, improving the quality of life. It is important to know the perspectives on the labor market for people with epilepsy and what the possible problems are. I describe a Dutch research project and give an overview of the findings concerning the employment and consequent employability of people with epilepsy and questions pertaining to employment and epilepsy. Possible interventions [i.e., public education and employment programs for people with epilepsy with the aim to improve the (re)integration of people with epilepsy into the labor market, thus improving the quality of life of (potential) employees with epilepsy], are described extensively.     

Lamotrigine Serum Concentration in Children With Epilepsy

The correlation between lamotrigine serum concentration, efficacy, and toxicity in children is controversial. The database of the Clinical Pharmacology Laboratory at Assaf Harofeh Medical Center was retrospectively searched to identify lamotrigine serum concentrations in children aged 2-19 years with refractory epilepsy who received lamotrigine as monotherapy or polytherapy from 2007-2010. Data collected included age at epilepsy onset, additional antiepileptic drugs, lamotrigine dose, monthly seizure frequency before and after lamotrigine treatment, and side effects. Sixty blood samples were collected from 42 children aged 10.1 ± 4.9 years (range, 2-20 years). Seizure types included complex partial (n = 28), simple partial (n = 7), absence (n = 2), and generalized tonic-clonic (n = 23). Decreased seizure frequency was observed in 38 (63.3%) patients. No correlation with lamotrigine serum concentration was evident, but seizure frequency was significantly influenced by age and lamotrigine dose. Side effects were reported in 21 (35%) patients. Only diplopia was significantly correlated with lamotrigine serum concentration. Lamotrigine was more effective at lower doses and in older children. Lamotrigine serum concentration correlated significantly with diplopia, but not with other side effects or with clinical efficacy. Overall, lamotrigine is effective and safe in children with refractory epilepsy.     

A Day-Centre for Severely Handicapped People with Epilepsy

The Skovlunde Day-Centre was founded by the Danish Epilepsy Association in 1968 and has been working for 3 years. It is situated in a suburb of greater Copenhagen, which has a population of 1,400,000. The institution receives patients or "pupils" from the whole area. Patients are referred from out-patient clinics for epileptics, general practitioners and from the only hospital for epileptics in Denmark, the Filadelfia Colony. The maximum capacity is 25 pupils. There are a few patients on the waiting list. We feel, however, that there is an undiscovered need for another centre in the area.     

Vocational Assessment and Intervention for People with Epilepsy

Summary:  Employment restrictions have been experienced by many people with epilepsy. In many cases, the restrictions are unjustified and based on stigma or a stereotypical image of the person with epilepsy. Unjustifiable restrictions are a form of discrimination and lead to unemployment and underemployment. Unfortunately, much of the research in this area has been difficult to interpret because of differences in the definition of "people with epilepsy" and differences in the definition of "employment restrictions or problems." I report on an attempt to develop a classification structure and examine some survey results collected by the IBE Employment Commission from professionals and people with epilepsy concerning the sources of employment restrictions and possible methods to overcome these restrictions.     

癫痫患者的生活质量及其评定工具

生活质量应能反映多维的健康状况,至少包括由疾病或治疗引起的生理、心理和社会效应。相关的生活质量评定工具通常分为一般(不针对特定的年龄、疾病或治疗组)和特异(针对特定的症状、疾病或与治疗相关的患者的情况)两种。理想的生活质量评定工具应满足正确性、使用的广泛性和量表内容的特异性。同时满足这3个要求的有WPSI,ESI-55,QOLIE,LiverpoolBatteries等,研究癫患者生活质量时可作为首选。另外SF-36,改良SEALS等满足其中两个要求,可根据需要选用,因为可与对照组比较,预计将来会得到更广泛的应用。其他的生活质量评定工具,都推荐作为次选。我们也建议同时使用一般和癫特异生活质量量表。     

Predictors of Suicidal Ideation in People with Epilepsy Living in Korea

Background and Purpose

The risk of suicide or suicide attempts is reported higher in people with epilepsy (PWE) than in the general population. Although epileptic, psychiatric, and psychosocial factors are known risk factors for suicide or suicide attempt, no studies have evaluated the predictors of the severity of suicidal ideation-which is a warning sign for suicide attempts-in PWE. Therefore, we measured the severity of suicidal ideation and its risk factors.

Methods

Consecutive PWE who were medicated with antiepileptic drugs (AEDs) and attended epilepsy clinic were included in the study. The subjects completed self-reported questionnaires, which included the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90-Revised (SCL-90-R), and Scale for Suicide Ideation-Beck (SSI-Beck). We compared the patients'' demographic and clinical variables, and BDI, BAI, and SCL-90-R scores with their SSI-Beck score, and used our findings to determine the predictors for suicidal ideation.

Results

In total, 257 PWE were enrolled in the study. SSI-Beck scores correlated strongly with several seizure-related variables, duration of education, IQ, BDI and BAI scores, and nine domains of the SCL-90-R questionnaire. However, the strongest predictor for suicidal ideation was BDI score (β=0.41, p<0.001), followed by several SCL-90-R domains, such as obsessive-compulsive (β=-0.39, p<0.001), depression (β=0.38, p<0.001), hostility (β=0.22, p=0.002), paranoid ideation (β=0.17, p=0.01), and IQ (β=-0.10, p=0.017). These variables explained 59% of the variance in the SSI-Beck score. The seizure-related variables that influenced the BDI score were seizure frequency, duration of education, MRI abnormality, and number of AEDs. However, these variables explained only 18% of the variance in the BDI score.

Conclusions

Major risk factors for suicidal ideation in PWE were depressive and psychiatric symptoms rather than seizure-related variables. Therefore, clinicians should focus on screening for depression and other psychiatric problems and treat them appropriately in order to reduce suicidal behavior in PWE. Since seizure-related variables also exhibited a minor role in determining depressive symptoms, stronger seizure-related risk factors for depression should be sought, such as seizure severity or psychosocial factors, to minimize suicidal behavior.