Counseling and Management of the Risks of Living With Epilepsy.
Counseling and Management of the Risks of Living With Epilepsy.
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DOI：
10.1212/con.0000000000000708
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发表时间：
2019-04-01
期刊：
影响因子：
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通讯作者：
Noe, Katherine
中科院分区：
文献类型：
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作者：
Noe, Katherine
综述目的：对于癫痫患者，生活质量不仅取决于癫痫发作的控制，还取决于情绪、抗癫痫药物的不良反应、人际关系以及接受教育、就业和交通的机会。本文综述了与癫痫相关的一些最常见的问题，包括情绪障碍、驾驶、伤害、死亡率、骨骼健康、遗传负担以及对关系的影响。研究结果：癫痫患者焦虑、抑郁和自杀的风险增加。抑郁症在癫痫患者中被低估了，但有效的筛查工具可供使用。癫痫患者的死亡率是普通人群的两倍，但这在很大程度上是由潜在疾病造成的，而不是癫痫发作。据估计，每年有1：1000的成人癫痫患者会发生癫痫猝死(SUDEP)，通过改进观察和癫痫发作控制可以降低这种风险。癫痫患者也会增加受伤的风险，包括骨折。骨骼健康降低导致骨折风险增加是长期使用抗癫痫药物的一个重要负面后果。开车时癫痫发作也会导致事故和受伤。尽管驾驶对于癫痫患者来说很重要，但医生在提供驾驶方面的建议方面表现不佳。总结：对癫痫患者的最佳护理包括解决情感健康、身体健康(包括骨折和SUDEP)、社会健康和独立生活方式的风险。识别和治疗以降低这些风险可以比仅仅关注癫痫发作控制的狭隘临床关注更有助于提高生活质量。
PURPOSE OF REVIEW: For patients living with epilepsy, quality of life is determined not only by seizure control but by mood, antiepileptic drug adverse effects, relationships, and access to education, employment, and transportation. This article reviews some of the most commonly encountered concerns associated with epilepsy, including mood disorders, driving, injuries, mortality, bone health, genetic burden, and impact on relationships.RECENT FINDINGS: People with epilepsy are at increased risk for anxiety, depression, and suicide. Depression is underrecognized in patients with epilepsy, but effective validated screening tools are available for use. Mortality rates for people with epilepsy are 2 times higher than those of the general population, but much of this is attributable to underlying conditions rather than seizures. Sudden unexpected death in epilepsy (SUDEP) occurs in an estimated 1:1000 adults with epilepsy per year, and the risk can be reduced by improved observation and seizure control. An increased risk of injury, including fractures, is also present in patients with epilepsy. Reduced bone health leading to increased fracture risk is an important negative consequence of long-term use of antiepileptic medication. Seizures while driving can also cause accidents and injury. Despite the importance of driving for people with epilepsy, physicians are underperforming in providing counsel about driving.SUMMARY: Optimal care of the patient with epilepsy includes addressing risks to emotional health, physical health including fractures and SUDEP, social health, and an independent lifestyle. Identification of and treatments to reduce these risks can do more to improve quality of life than a narrow clinical focus on seizure control alone.