Epilepsia：颞叶癫痫患儿常见抑郁症状

一项新的研究显示罹患颞叶癫痫的儿童和青少年有可能出现临床上明显的行为问题和精神疾病，尤其是抑郁。发表于由Wiley发行的国际抗癫痫联盟所属期刊之《癫痫》杂志的研究报告强调了对儿科癫痫患儿进行常规精神病评估的重要性，尤其是对那些对抗癫痫药物无效和需要进行外科干预治疗的患儿。

现有的医学证据表明40%的儿科癫痫患儿出现精神病况，抑郁、焦虑、注意力问题和学习困难是其中最常见的精神病征。而且据Sanchez-Gistau等2009年报道的成为共同关注焦点的外科治疗癫痫的研究发现在成人外科手术患者中抑郁与颞叶癫痫存在相关性。但是这些证据并未很好地立足于儿科病人身上且为现行研究所关注。

牵头该研究的华盛顿全国儿童医疗中心的Jay Salpekar博士介绍说：“我们的研究是把对抗癫痫药物无效的颞叶癫痫患儿与大脑其它部位（异常电活动）所致癫痫患儿相比较以确定是否前者更常出现精神病况。对药物治疗无效的癫痫患儿而言，外科手术治疗癫痫可能是提高他们的生活质量的唯一选择。因为精神病况的严重程度可能影响癫痫的外科手术治疗的整体的风险效益，故清楚患儿的精神健康状况是重要的。”

该研究的研究人员回顾了年龄介于6至17岁的40例对抗癫痫药物治疗无效的病例资料。这些患儿均予行术前精神病评估，他们的父母则完成了儿童行为量表。癫痫病专家均对癫痫定位和外科手术适应症进行了确认。

研究人员发现颞叶癫痫患儿组与所报道的慢性癫痫患儿相比较其出现典型的精神病和行为问题的差异显著。差不多80%的颞叶癫痫患儿出现明显的精神病症状，这远远高于慢性癫痫患儿通常只有20%～40%的精神病发病率。而且据患儿父母们的报告称颞叶癫痫的患儿比大脑其它部位（异常电活动）所致癫痫的患儿更常伴发抑郁症状和其它明显的行为问题。

Psychiatric symptoms in children prior to epilepsy surgery differ according to suspected seizure focus.
PURPOSE
Children and adolescents with epilepsy have an overrepresentation of psychiatric illness. However, few studies in pediatrics have characterized specific psychiatric conditions associated with seizure localization. In addition, degree to which psychiatric illness may be more prominent in children refractory to standard medical treatment for epilepsy is not known. The aim of this study was to assess psychiatric symptoms in children with medically refractory epilepsy and ascertain whether symptoms were associated with specific localization.
METHODS
Case records were reviewed for 40 children with medically refractory epilepsy at the time of their referral for presurgical evaluation. Patients received a clinical psychiatric evaluation and parents completed the Child Behavioral Checklist (CBCL). Seizure localization was verified by pediatric epileptologists, and suitability for surgical procedures was verified by neurosurgical specialists. Groups were compared based on localization of seizure foci, either in the temporal lobe or predominantly extratemporal.
KEY FINDINGS
The majority of the sample had psychiatric diagnoses and behavior problems, well beyond the level reported in chronic epilepsy populations. In addition, children with temporal lobe seizure foci had more CBCL behavioral problem categories rated in the clinically significant range, and also were more likely to have clinical diagnoses of depression.
SIGNIFICANCE
Routine psychiatric evaluation prior to epilepsy surgery may be important for pediatric patients with medically refractory epilepsy. Psychiatric illness, particularly depression, may be especially prominent for those with temporal lobe seizure foci.