Annals of Neurology: 癫痫发作后精神病由癫痫和精神病遗传易感性共同作用造成

2021-07-31 自由影像之光 MedSci原创

在一种常见疾病中,疾病生物学(癫痫发作)和特质易感性(精神分裂症)相互作用产生了特定结果(发作后精神病)。

精神障碍在癫痫中很常见,影响高达50%的患者;局灶性癫痫的患病率高于特发性全身性癫痫,尤其是涉及颞叶的癫痫。癫痫的广谱精神谱系包括情感障碍(最常见的是抑郁)、焦虑障碍、注意力缺陷多动障碍和精神障碍。癫痫的精神障碍包括:,癫痫发作间性精神病(与急性发作无关的);发作后精神病(发生在癫痫发作后长达48小时的清醒间隔之后);抗癫痫药物(ASM)引起的精神病性障碍(暴露于ASM期间、之后不久、停药期间或之后不久出现精神病性症状)影响癫痫患者的精神疾病增加了疾病负担,降低了生活质量。

6%的癫痫患者患有精神病;与普通人群相比,癫痫患者患精神病的风险几乎增加了8倍。癫痫患者中精神分裂症样精神病的发病率是普通人群的三倍;癫痫发作后精神病的总体患病率估计为2%,颞叶癫痫患者的患病率上升至7%然而,发作后精神病的病因不明。先前的研究表明癫痫和精神病有共同的病理生理机制或共同的遗传易感性。

Braatz V等描述了癫痫发作后精神病的特征,确定与发作后精神病相关的临床和遗传特征。该研究性论文发表在Ann Neurol.杂志。

该研究为病例对照队列研究,研究对象为经精神病学评估证实癫痫发作后精神病患者,收集了关于癫痫、治疗、精神病史、精神病概况和结果的可用数据。

在对3288例癫痫患者进行筛查后,发现83例患有精神病,49例患有发作后精神病。对照组为98名成年人,年龄和癫痫组匹配,无精神病史。Logistic回归分析影响发作后精神障碍的临床因素;P值<0.20的单变量关联用于建立多变量模型。计算精神分裂症的多基因风险评分。

不同P值阈值下精神分裂症多基因风险评分(PRS)模型拟合的条形图。

全基因组精神分裂症(SCZ)多基因风险评分(PRS)。

(A)单次发作后精神病患者的精神分裂症PRS与反复发作患者和继续发展为慢性精神病患者的PRS进行比较。(B)有或无精神病家族史的发作后精神病患者的精神分裂症PRS。

患者组更有可能为聚集性发作(OR 7.59,P<0.001)、先兆发作(OR 2.49,P=0.013)、精神病家族史(OR 5.17,P=0.022)。右颞区癫痫样放电占多数(OR 4.87,P=0.007)。在癫痫持续时间、神经影像学表现或抗癫痫治疗方面,病例组与对照组无差异。在一个扩大的发作后精神病患者队列中(58),精神分裂症的多基因风险评分显著高于1366名癫痫对照组(R2=3%,P=6×10-3),但与945名独立的精神分裂症患者(R2=0.1%,P=0.775)没有显著差异。

发作后精神病是癫痫患者的重要神经精神表现。Braatz V等的研究表明有临床因素与发作后精神病的发生有关。慢性疾病(此处为发作后精神病)中特定现象的出现可能是这些现象的遗传易感性(此处为精神分裂症的PRS升高)和慢性疾病本身的后果(此处为癫痫发作群)的结合造成的。如果得到经验数据的支持,该模型将进一步支持获得全面的个体遗传信息在每个癫痫患者诊断中的价值。

发作后精神病在特殊情况下发生在具有高度遗传易感性的癫痫患者中,说明在一种常见疾病中,疾病生物学(癫痫发作)和特质易感性(精神分裂症)相互作用产生了特定结果(发作后精神病)。

原文出处

Braatz V, Martins Custodio H, Leu C, et al. Post-ictal psychosis in epilepsy: A clinico-genetic study [published online ahead of print, 2021 Jul 20]. Ann Neurol. 2021;10.1002/ana.26174. doi:10.1002/ana.26174

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    2022-01-03 yinhl1978
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    2021-09-19 1487042cm12暂无昵称

    学习

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