DEPRESSION AND HEALTH OUTCOMES IN REFRACTORY EPILEPSY

描述(申请人提供)：癫痫是最常见的致残 神经系统疾病，抑郁症是最常见的并存疾病 与癫痫有关。年抑郁症的患病率为20%-50% 癫痫发作不受控制的患者。这一组合影响到25万人 美国有45万人。我们最近的临床研究表明 抑郁症是功能和健康结果的有力预测因素 癫痫。尽管有明显的不良反应和抑郁症的高患病率 在癫痫方面，大多数受影响的患者都得不到治疗。这种自满的态度 治疗可能是由于不充分使用诊断筛查而产生的， 人们普遍认为抗抑郁剂降低了癫痫发作的阈值，或缺乏 在抗抑郁药的唯一对照试验中证明了疗效 治疗癫痫的药物。这项研究的主要目的是界定 抗抑郁药物治疗对情绪、依从性和健康结局的好处 在癫痫患者中合并重度抑郁症。根据我们之前的记录 临床和研究经验，我们假设1)药物治疗或 心理治疗将减少抑郁，提高与健康相关的生活质量 难治性癫痫患者：2)抗癫痫药物依从性 抑郁减轻后会有所改善，3)发作频率不会 选择性5-羟色胺再摄取治疗期间显著增加 抑制剂与心理疗法的比较，以及4)抑郁症和抗癫痫药 药物毒性是健康相关生活质量的更强预测因素 难治性癫痫患者的癫痫发作频率或严重程度。这个 假说将通过一项随机试验来检验，该试验比较了 舍曲林(n=127)用于情绪和健康的认知行为疗法(n=127) 难治性癫痫和抑郁症患者的预后。可靠且 将使用有效的措施来评估抑郁症和健康相关质量 生活。电子的、计算机辅助的监测将决定遵守情况。 将使用多变量重复测量分析来确定 治疗、情绪、抗癫痫药物毒性、 癫痫发作频率和严重程度、依从性和与健康相关的生活质量。 我们预计，积极研究结果的传播将 支持对目前的癫痫干预模式进行修改 主要是减少癫痫发作，以采取更全面的方法，包括 抑郁症的评估和治疗

DESCRIPTION (provided by applicant): Epilepsy is the most prevalent disabling neurologic illness, and depression is the most frequent comorbid condition associated with epilepsy. The prevalence of depression is 20-50 percent in patients with uncontrolled seizures. This combination affects between 250,000 and 450,000 people in the United States. Our recent clinical studies have shown that depression is a strong predictor of function and health outcomes in epilepsy. Despite the marked adverse effects and high prevalence of depression in epilepsy, most affected patients are not treated. This complacency toward treatment may result from insufficient use of diagnostic screening, the widespread belief that antidepressants lower the seizure threshold, or lack of demonstrated efficacy in the only controlled trial of antidepressant medications in epilepsy. The broad aims of this study are to define the benefits of antidepressant treatment on mood, compliance, and health outcomes in epilepsy patients with comorbid major depression. Based on our prior clinical and research experience, we hypothesize that 1) pharmacotherapy or psychotherapy will reduce depression and improve health-related quality of life in patients with refractory epilepsy, 2) antiepileptic medication compliance will improve after reduction of depression, 3) seizure frequency will not significantly increase during treatment with a selective seratonin reuptake inhibitor compared to psychotherapy, and 4) depression and antiepileptic medication toxicity are stronger predictors of health-related quality of life than seizure frequency or severity in patients with refractory epilepsy. The hypotheses will be tested through a randomized trial comparing the efficacy of sertraline (n=127) to cognitive behavior therapy (n=127) for mood and health outcomes in patients with refractory epilepsy and depression. Reliable and valid measures will be used to assess depression and health-related quality of life. Electronic, computer-assisted monitoring will determine compliance. Multivariate repeated-measures analyses will be used to determine the interrelationships of treatment, mood, antiepileptic medication toxicity, seizure frequency and severity, compliance and health-related quality of life. We anticipate that dissemination of the results of a positive study will support the modification of the current model of intervention for epilepsy from predominantly seizure reduction to a more comprehensive approach that includes assessment and treatment of depression