Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery?
Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery?
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DOI：
10.1016/j.yebeh.2009.01.002
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发表时间：
2009-03-01
影响因子：
2.6
通讯作者：
Sakamoto, Americo C.
中科院分区：
文献类型：
--
作者：
Guarnieri, Ricardo;Walz, Roger;Sakamoto, Americo C.
临床和人口统计学的术前变量可能与伴有海马硬化症的内侧颞叶癫痫 (MTLE-HS) 患者不良的术后神经学结果相关。然而，很少有报告将术前精神疾病作为预测术后长期 MTLE-HS 神经系统结果的因素。我们使用 Engel 的标准对 186 名 MTLE-HS 术后患者进行了平均 6 年的随访。 DSM-IV 标准和癫痫特有的精神科合并症标准（发作间期烦躁障碍、发作后和发作间期精神病）用于评估术前精神疾病。使用无条件逻辑回归估计 Kaplan-Meier 无事件生存率和调整后的危险比。 77 名 (41.4%) 患者术前有 Axis I 精神病学诊断。 36 名患者患有抑郁症、发作间期烦躁障碍、14 名发作间期精神病、6 名发作后精神病和 10 名焦虑症。 23 名 (12.4%) 患者患有 Axis 11 人格障碍。关于癫痫发作结果，术前焦虑症（P = 0.009）和人格障碍（P = 0.003）与Engel I B级（剩余先兆）或更高等级呈正相关。这些发现强调了癫痫和精神疾病患者术前精神评估、咨询和术后随访的重要性。 (C) 2009 Elsevier Inc. 保留所有权利。
Clinical and demographic presurgical variables may be associated with unfavorable postsurgical neurological outcome in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). However, few reports include preoperative psychiatric disorders as a factor predictive of long-term post-surgical MTLE-HS neurological Outcome. We used Engel's criteria to follow 186 postsurgical patients with MTLE-HS for an average of 6 years. DSM-IV criteria and psychiatric comorbidity criteria specific to epilepsy (interictal dysphoric disorder, postictal and interictal psychosis) were used to assess presurgical psychiatric disorders. Kaplan-Meier event-free Survival and adjusted hazard ratios were estimated with unconditional logistic regression. Seventy-seven (41.4%) patients had a preoperative Axis I psychiatric diagnosis. Thirty-six patients had depression, I I interictal dysphoric disorder, 14 interictal psychosis, 6 postictal psychosis, and 10 anxiety disorders. Twenty-three (12.4%) patients had Axis 11 personality disorders. Regarding seizure outcome, preoperative anxiety disorders (P = 0.009) and personality disorders (P = 0.003) were positively Correlated with Engel class I B (remaining auras) or higher. These findings emphasize the importance of presurgical psychiatric evaluation, counseling, and Postsurgical follow-up of patients with epilepsy and psychiatric disorders. (C) 2009 Elsevier Inc. All rights reserved.