Pre-surgical predictors for psychiatric disorders following epilepsy surgery in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis
Pre-surgical predictors for psychiatric disorders following epilepsy surgery in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis
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DOI：
10.1016/j.eplepsyres.2012.05.005
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发表时间：
2012-11-01
影响因子：
2.2
通讯作者：
Targas Yacubian, Elza Marcia
中科院分区：
文献类型：
--
作者：
de Araujo Filho, Gerardo Maria;Mazetto, Lenon;Targas Yacubian, Elza Marcia
由于癫痫手术患者术前精神疾病（PD）的患病率较高，因此对癫痫手术患者的精神病学结局特别关注。本研究的目的是验证一个同质系列的难治性颞叶癫痫和内侧颞叶硬化症（TLE-MTS）患者癫痫手术后精神障碍的可能的术前预测因素。纳入了115例接受皮质-杏仁核campectomy的TLE-MTS患者（65例女性; 56.5%）的数据。术前和术后的精神评估进行了DSM-IV标准。47名患者（40.8%）被诊断出术前PD --特别是情绪、焦虑和精神病性障碍。27例患者（54%的术前PD患者）在术后精神评估中表现出精神症状缓解。11例患者（9.6%）发生新发PD。术前抑郁（OR= 3.32; p=0.008）、术前发作间期精神病（OR = 4.39; p=0.009）和致痫区对侧癫痫样放电（OR = 2.73; p = 0.01）的存在是与术后PD相关的风险因素。虽然癫痫手术被认为是难治性TLE-MTS患者的最佳治疗选择，但在手术候选人中观察到的相对较高的精神病合并症及其对术后结局的可能负面影响需要对临床，社会人口统计学和精神因素进行仔细的术前评估。(C)2012爱思唯尔有限公司版权所有。
Psychiatric outcomes of patients submitted to epilepsy surgery have gained particular interest given the high prevalence of pre-surgical psychiatric disorders (PD) in this population. The present study aimed to verify the possible pre-surgical predictors for psychiatric disorders following epilepsy surgery in a homogeneous series of patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). Data from 115 TLE-MTS patients (65 females; 56.5%) who underwent cortico-amygdalohippocampectomy were included. Pre- and post-surgical psychiatric evaluations were performed using DSM-IV criteria. Pre-surgical PD - particularly mood, anxiety and psychotic disorders - were diagnosed in 47 patients (40.8%). Twenty-seven patients (54% of those with pre-surgical PD) demonstrated a remission of psychiatric symptoms on post-surgical psychiatric evaluation. Eleven patients (9.6%) developed de novo PD. The presence of pre-surgical depression (OR= 3.32; p=0.008), pre-surgical interictal psychosis (OR = 4.39; p=0.009) and epileptiform discharges contralateral to the epileptogenic zone (OR = 2.73; p = 0.01) were risk factors associated with post-surgical PD. Although epilepsy surgery is considered to be the best treatment option for patients with refractory TLE-MTS, the relatively high psychiatric comorbidities observed in surgical candidates and their possible negative impact on post-surgical outcomes require a careful pre-surgical evaluation of clinical, sociodemographic and psychiatric factors. (C) 2012 Elsevier B.V. All rights reserved.