中国西部地区成人癫痫共患病现状及影响因素
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摘要
目的研究中国西部地区成年人癫痫常见共患病现状,分析其相关危险因素。方法收集2017年4月—2018年3月就诊于四川省人民医院神经内科癫痫中心的199例癫痫患者,采用中文版广泛焦虑量表、癫痫抑郁量表、匹兹堡睡眠质量指数量表和Epworth嗜睡量表等进行评估。采用Logistic回归分析癫痫共患病的相关危险因素。结果 199例成人癫痫患者中28.1%共患焦虑,17.1%共患抑郁,33.2%共患睡眠障碍,2.5%共患偏头痛。140例患者单药治疗,包括卡马西平(CBZ)15例、拉莫三嗪(LTG)20例、左乙拉西坦(LEV)26例、托吡酯(TPM)31例、奥卡西平(OXC)25例、丙戊酸钠(VPA)23例。单药治疗的癫痫患者Logistic回归分析显示:发作频率≥1次/月、LEV、TPM、睡眠障碍是癫痫共患焦虑的独立危险因素(P<0.05);无业、近3个月有临床发作、睡眠障碍是共患抑郁的独立危险因素(P<0.05);焦虑、抑郁、白天嗜睡、CBZ、LTG是共患睡眠障碍的独立危险因素(P<0.05)。结论焦虑、抑郁、睡眠障碍是中国西部地区成人癫痫患者常见的共患病。对存在情感障碍及睡眠障碍的患者,早期识别和积极干预癫痫共患病,对改善患者生活质量及预后可能具有重要意义。LEV、TPM单药治疗的患者发生焦虑的风险高于其他药物,LTG、CBZ单药治疗的患者更容易共患睡眠障碍。
Objective To explore the status of common comorbidities in adult epilepsy patients in western China,and to explore the related risk factors.Methods The Chinese version of Generalized Anxiety Disorder(GAD)-7,neurological disorders depression inventory for epilepsy(NDDI-E)scales,Pittsburgh sleep quality index scale(PSQI)and epworth sleepiness scale(ESS)were used to evaluate the 199 epilepsy patients between April 2017 and March 2018 in the Epilepsy Center of Neurology Department of Sichuan People's Hospital.Logistic regression analysis was performed on the risk factors of epilepsy comorbidity.Results In the 199 adult epilepsy patients,28.1%had anxiety,17.1%had depression,33.2%had sleep disorder,and 2.5%had migraine.140 patients received monotherapy,including 15 patients with carbamazepine(CBZ),20 patients with lamotrigine(LTG),26 patients with levetiracetam(LEV),31 patients with topiramate(TPM),25 patients with oxcarbazepine(OXC),and 23 patients with Valproate(VPA).Multivariate logistic regression analysis of epilepsy patients treated with monotherapy showed that seizure occurring more than once a month,LEV,TPM,sleep disorders were independent risk factors for anxiety in patients with epilepsy(P<0.05).Unemployment,seizure occurrence in the last three months,sleep disorders were independent risk factors for comorbid depression(P<0.05).Anxiety,depression,daytime sleepiness,CBZ,LTG were independent risk factors for comorbid sleep disorders(P<0.05).Conclusions Anxiety,depression and sleep disorder are common comorbidities in adults with epilepsy in westChina.For patients with affective disorder and sleep disorder,early identification and intervention may be important to improve the quality of life and prognosis of patients.In addition,patients treated with LEV or TPM monotherapy had a higher risk of anxiety than other drugs.Patients with LTG and CBZ monotherapy are more likely to comorbid sleep disorders.
Objective To explore the status of common comorbidities in adult epilepsy patients in western China,and to explore the related risk factors.Methods The Chinese version of Generalized Anxiety Disorder(GAD)-7,neurological disorders depression inventory for epilepsy(NDDI-E)scales,Pittsburgh sleep quality index scale(PSQI)and epworth sleepiness scale(ESS)were used to evaluate the 199 epilepsy patients between April 2017 and March 2018 in the Epilepsy Center of Neurology Department of Sichuan People's Hospital.Logistic regression analysis was performed on the risk factors of epilepsy comorbidity.Results In the 199 adult epilepsy patients,28.1%had anxiety,17.1%had depression,33.2%had sleep disorder,and 2.5%had migraine.140 patients received monotherapy,including 15 patients with carbamazepine(CBZ),20 patients with lamotrigine(LTG),26 patients with levetiracetam(LEV),31 patients with topiramate(TPM),25 patients with oxcarbazepine(OXC),and 23 patients with Valproate(VPA).Multivariate logistic regression analysis of epilepsy patients treated with monotherapy showed that seizure occurring more than once a month,LEV,TPM,sleep disorders were independent risk factors for anxiety in patients with epilepsy(P<0.05).Unemployment,seizure occurrence in the last three months,sleep disorders were independent risk factors for comorbid depression(P<0.05).Anxiety,depression,daytime sleepiness,CBZ,LTG were independent risk factors for comorbid sleep disorders(P<0.05).Conclusions Anxiety,depression and sleep disorder are common comorbidities in adults with epilepsy in westChina.For patients with affective disorder and sleep disorder,early identification and intervention may be important to improve the quality of life and prognosis of patients.In addition,patients treated with LEV or TPM monotherapy had a higher risk of anxiety than other drugs.Patients with LTG and CBZ monotherapy are more likely to comorbid sleep disorders.
引文
1王艺霖,张鸿.癫痫躯体共患病的研究进展.癫痫杂志,2018,4(4):334-339.
2 Bifftu BB,Dachew BA,BT T.Depression amongpeople with epilepsy in Northwest Ethiopia:a cross-sectional institution based study.Afr Health Sci,2015,15(4):1211-1219.
3 Macedo P,Oliveira P S,Foldvary-Schaefer N,et al.Insomnia in people with epilepsy:A review of insomnia prevalence,risk factors and associations with epilepsy-related factors.Epilepsy Res,2017,135:158-167.
4 Prisnie JC,Sajobi TT,Wang M.Effects of depression and anxiety on quality of life in five common neurological disorders.Gen Hosp Psychiatry,2018,52:58-63.
5 Seo JG,Cho YW,Lee SJ,et al. Validation of the generalized anxiety disorder-7 in people with epilepsy:a MEPSY study.Epilepsy Behav,2014,35:59-63.
6 Tong X,An D,McGonigal A,et al. Validation of the Generalized Anxiety Disorder-7(GAD-7)among Chinese people with epilepsy.Epilepsy Res,2016,120:31-36.
7 Gill SJ,Lukmanji S,Fiest KM,et al. Depression screening tools in persons with epilepsy:A systematic review of validated tools.Epilepsia,2017,58(5):695-705.
8 Tong X,An D,Lan L.Validation of the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy(CNDDI-E)in West China.Epilepsy Behav,2015,47:6-10.
9 Buysse DJ,Reynolds CF,Monk TH,et al. The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research.PsychiatryRes,1989,28(2):193-213.
10彭莉莉,李进让,孙建军,等.Epworth嗜睡量表简体中文版信度和效度评价.中华耳鼻咽喉头颈外科杂志,2011,46(1):44-49.
11 Headache Classification Committee of the International Headache Society.Classification and diagnostic criteria for headache disorders,cranial neuralgias and facial pain.Cephalalgia,1988,8(Suppl 7):1-96.
12 Kimiskidis VK,Triantafyllou NI,Kararizou E,et al. Depression and anxiety in epilepsy:the association with demographic and seizure-related variables.Ann Gen Psychiatry,2007,6:28.
13中国抗癫痫协会共患病专业委员会.癫痫伴焦虑诊断治疗的中国专家共识.癫痫杂志,2018,4(3):185-190.
14 Munger CH.Anxiety and epilepsy:what neurologists and epileptologists should know.Curr Neurol Neurosci Rep,2014,14(5):445.
15 Kanner AM.Anxiety disorders in epilepsy:the forgotten psychiatric comorbidity.Epilepsy Curr,2011,11(3):90-91.
16 Garcia ME,Garcia-Morales I,Gil-Nagel A.Prevalence of depressive symptoms and their impact on quality of life in patients with drug-resistant focal epilepsy(IMDYVA study).Epilepsy Res,2015,110:157-165.
17 Wang HJ,Tan G,Deng Y,et al. Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China.Acta Neurol Scand,2018,138(6):541-547.
18 Bifftu BB,Dachew BA,Tiruneh BT,et al.Depression among people with epilepsy in Northwest Ethiopia:a cross-sectional institution based study.BMC Res Notes,2015,8:585.
19 Chen E,Sajatovic M,Liu H.Demographic and Clinical Correlates of Seizure Frequency:Findings from the Managing Epilepsy Well Network Database.J Clin Neurol,2018,14(2):206-211.
20 Owolabi SD,Owolabi LF,Udofia O,et al.Depression in patients with epilepsy in Northwestern Nigeria:Prevalence and clinical correlates.Ann Afr Med,2016,15(4):179-184.
21 Kwon OY,Park SP.Depression and anxiety in people with epilepsy.J Clin Neurol,2014,10(3):175-188.
22赵梦娇,赵玉华.102例西藏地区癫痫患者共患抑郁、焦虑和抑郁伴焦虑的分析.癫痫杂志,2018,4(5):400-405.
23 de Oliveira GN,Lessa JM,Goncalves AP,et al.Screening for depression in people with epilepsy:comparative study among neurological disorders depression inventory for epilepsy(NDDIE),hospital anxiety and depression scale depression subscale(HADS-D),and Beck depression inventory(BDI).Epilepsy Behav,2014,34:50-54.
24 Zis P,Yfanti P,Siatouni A,et al.Determinants of depression among patients with epilepsy in Athens,Greece.Epilepsy Behav,2014,33:106-109.
25 Wang L,Gu XM,Hao BY,et al. Influence of marital status on the quality of life of Chinese adult patients with epilepsy.Chin Med J(Engl),2017,130(1):83-87.
26 Pereira AM,Bruni O,Ferri R,et al.The impact of epilepsy on sleep architecture during childhood.Epilepsia,2012,53(9):1519-1525.
27 Xu X,Brandenburg NA,McDermott AM,et al. Sleep disturbances reported by refractory partial-onset epilepsy patients receiving polytherapy.Epilepsia,2006,47(7):1176-1183.
28 Moser D,Pablik E,Aull-Watschinger S,et al. Depressive symptoms predict the quality of sleep in patients with partial epilepsy--a combined retrospective and prospective study.Epilepsy Behav,2015,47:104-110.
29 Sivertsen B,Harvey AG,Lundervold AJ,et al. Sleep problems and depression in adolescence:results from a large population-based study of Norwegian adolescents aged 16-18 years.Eur Child Adolesc Psychiatry,2014,23(8):681-689.
30 de Weerd A,de Haas S,Otte A,et al. Subjective sleep disturbance in patients with partial epilepsy:a questionnaire-based study on prevalence and impact on quality of life.Epilepsia,2004,45(11):1397-1404.
31 Park SP,Song HS,Hwang YH,et al. Differential effects of seizure control and affective symptoms on quality of life in people with epilepsy.Epilepsy Behav,2010,18(4):455-459.
32 Sirsi D,Safdieh JE.The safety of levetiracetam.Expert Opin Drug Saf,2007,6(3):241-250.
33 Verrotti A,Prezioso G,Di Sabatino F,et al.The adverse event profile of levetiracetam:A meta-analysis on children and adults.Seizure,2015,31:49-55.
34 Chen B,Choi H,Hirsch LJ,et al. Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy.Epilepsy Behav,2017,76:24-31.
35 Cramer JA,De Rue K,Devinsky O,et al. A systematic review of thebehavioral effects of levetiracetam in adults with epilepsy,cognitive disorders,or an anxiety disorder during clinical trials.Epilepsy Behav,2003,4(2):124-132.
36 Nickel C,Lahmann C,Tritt K,et al.Topiramate in treatment of depressive and anger symptoms in female depressive patients:a randomized,double-blind,placebo-controlled study.J Affect Disord,2005,87(2-3):243-252.
37 Carpenter LL,Leon Z,Yasmin S,et al. Do obese depressed patients respond to topiramate? A retrospective chart review.J Affect Disord,2002,69(1-3):251-255.
38 Hussain MZ,Chaudhry ZA.Topiramate in treatment of refractory bipolar depression.J Affective disorders and antidepressants,2002,3:199-200.
39 Boylan LS,Devinsky O,Barry JJ,et al.Psychiatric uses of antiepileptic treatments.Epilepsy Behav,2002,3(5S):54-59.
40 Drane DL,Meador KJ.Cognitive and behavioral effects of antiepileptic drugs.Epilepsy Behav,2002,3(5S):49-53.
41 Dussaule C,Bouilleret V.Psychiatric effects of antiepileptic drugs in adults.Geriatr Psychol Neuropsychiatr Vieil,2018,16(2):181-188.
42 Eddy CM,Rickards HE,Cavanna AE.Behavioral adverse effects of antiepileptic drugs in epilepsy.J Clin Psychopharmacol,2012,32(3):362-375.
43 Tzitiridou M,Panou T,Ramantani G,et al.Oxcarbazepine monotherapy in benign childhood epilepsy with centrotemporalspikes:a clinical and cognitive evaluation.Epilepsy Behav,2005,7(3):458-467.
44 Biton V,Shneker BF,Naritoku D,et al. Long-term tolerability and safety of lamotrigine extended-release:pooled analysis of three clinical trials.Clin Drug Investig,2013,33(5):359-364.
45 Jain SV,Glauser TA.Effects of epilepsy treatments on sleep architecture and daytime sleepiness:an evidence-based review of objective sleep metrics.Epilepsia,2014,55(1):26-37.
46 Vaughn BV,D'Cruz OF.Sleep and epilepsy.Semin Neurol,2004,24(3):301-313.
47 Shen Y,Zhang M,Wang Y,et al.Subjective sleep disturbance in Chinese adults with epilepsy:associations with affective symptoms.Epilepsy Res,2017:135150-157.
48 Foldvary N,Perry M,Lee J,et al. The effects of lamotrigine on sleep in patients with epilepsy.Epilepsia,2001,42(12):1569-1573.
49 Jabbehdari S,Hesami O,Chavoshnejad M.Prevalence of Migraine Headache in Epileptic Patients.Acta Med Iran,2015,53(6):373-375.
50 Wang XQ,Lang SY,Zhang X.Comorbidity between headache and epilepsy in a Chinese epileptic center.Epilepsy Res,2014,108(3):535-541.
51 Ottman R,Lipton RB.Is the comorbidity of epilepsy and migraine due to a shared genetic susceptibility?Neurology,1996,47(4):918-924.
2 Bifftu BB,Dachew BA,BT T.Depression amongpeople with epilepsy in Northwest Ethiopia:a cross-sectional institution based study.Afr Health Sci,2015,15(4):1211-1219.
3 Macedo P,Oliveira P S,Foldvary-Schaefer N,et al.Insomnia in people with epilepsy:A review of insomnia prevalence,risk factors and associations with epilepsy-related factors.Epilepsy Res,2017,135:158-167.
4 Prisnie JC,Sajobi TT,Wang M.Effects of depression and anxiety on quality of life in five common neurological disorders.Gen Hosp Psychiatry,2018,52:58-63.
5 Seo JG,Cho YW,Lee SJ,et al. Validation of the generalized anxiety disorder-7 in people with epilepsy:a MEPSY study.Epilepsy Behav,2014,35:59-63.
6 Tong X,An D,McGonigal A,et al. Validation of the Generalized Anxiety Disorder-7(GAD-7)among Chinese people with epilepsy.Epilepsy Res,2016,120:31-36.
7 Gill SJ,Lukmanji S,Fiest KM,et al. Depression screening tools in persons with epilepsy:A systematic review of validated tools.Epilepsia,2017,58(5):695-705.
8 Tong X,An D,Lan L.Validation of the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy(CNDDI-E)in West China.Epilepsy Behav,2015,47:6-10.
9 Buysse DJ,Reynolds CF,Monk TH,et al. The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research.PsychiatryRes,1989,28(2):193-213.
10彭莉莉,李进让,孙建军,等.Epworth嗜睡量表简体中文版信度和效度评价.中华耳鼻咽喉头颈外科杂志,2011,46(1):44-49.
11 Headache Classification Committee of the International Headache Society.Classification and diagnostic criteria for headache disorders,cranial neuralgias and facial pain.Cephalalgia,1988,8(Suppl 7):1-96.
12 Kimiskidis VK,Triantafyllou NI,Kararizou E,et al. Depression and anxiety in epilepsy:the association with demographic and seizure-related variables.Ann Gen Psychiatry,2007,6:28.
13中国抗癫痫协会共患病专业委员会.癫痫伴焦虑诊断治疗的中国专家共识.癫痫杂志,2018,4(3):185-190.
14 Munger CH.Anxiety and epilepsy:what neurologists and epileptologists should know.Curr Neurol Neurosci Rep,2014,14(5):445.
15 Kanner AM.Anxiety disorders in epilepsy:the forgotten psychiatric comorbidity.Epilepsy Curr,2011,11(3):90-91.
16 Garcia ME,Garcia-Morales I,Gil-Nagel A.Prevalence of depressive symptoms and their impact on quality of life in patients with drug-resistant focal epilepsy(IMDYVA study).Epilepsy Res,2015,110:157-165.
17 Wang HJ,Tan G,Deng Y,et al. Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China.Acta Neurol Scand,2018,138(6):541-547.
18 Bifftu BB,Dachew BA,Tiruneh BT,et al.Depression among people with epilepsy in Northwest Ethiopia:a cross-sectional institution based study.BMC Res Notes,2015,8:585.
19 Chen E,Sajatovic M,Liu H.Demographic and Clinical Correlates of Seizure Frequency:Findings from the Managing Epilepsy Well Network Database.J Clin Neurol,2018,14(2):206-211.
20 Owolabi SD,Owolabi LF,Udofia O,et al.Depression in patients with epilepsy in Northwestern Nigeria:Prevalence and clinical correlates.Ann Afr Med,2016,15(4):179-184.
21 Kwon OY,Park SP.Depression and anxiety in people with epilepsy.J Clin Neurol,2014,10(3):175-188.
22赵梦娇,赵玉华.102例西藏地区癫痫患者共患抑郁、焦虑和抑郁伴焦虑的分析.癫痫杂志,2018,4(5):400-405.
23 de Oliveira GN,Lessa JM,Goncalves AP,et al.Screening for depression in people with epilepsy:comparative study among neurological disorders depression inventory for epilepsy(NDDIE),hospital anxiety and depression scale depression subscale(HADS-D),and Beck depression inventory(BDI).Epilepsy Behav,2014,34:50-54.
24 Zis P,Yfanti P,Siatouni A,et al.Determinants of depression among patients with epilepsy in Athens,Greece.Epilepsy Behav,2014,33:106-109.
25 Wang L,Gu XM,Hao BY,et al. Influence of marital status on the quality of life of Chinese adult patients with epilepsy.Chin Med J(Engl),2017,130(1):83-87.
26 Pereira AM,Bruni O,Ferri R,et al.The impact of epilepsy on sleep architecture during childhood.Epilepsia,2012,53(9):1519-1525.
27 Xu X,Brandenburg NA,McDermott AM,et al. Sleep disturbances reported by refractory partial-onset epilepsy patients receiving polytherapy.Epilepsia,2006,47(7):1176-1183.
28 Moser D,Pablik E,Aull-Watschinger S,et al. Depressive symptoms predict the quality of sleep in patients with partial epilepsy--a combined retrospective and prospective study.Epilepsy Behav,2015,47:104-110.
29 Sivertsen B,Harvey AG,Lundervold AJ,et al. Sleep problems and depression in adolescence:results from a large population-based study of Norwegian adolescents aged 16-18 years.Eur Child Adolesc Psychiatry,2014,23(8):681-689.
30 de Weerd A,de Haas S,Otte A,et al. Subjective sleep disturbance in patients with partial epilepsy:a questionnaire-based study on prevalence and impact on quality of life.Epilepsia,2004,45(11):1397-1404.
31 Park SP,Song HS,Hwang YH,et al. Differential effects of seizure control and affective symptoms on quality of life in people with epilepsy.Epilepsy Behav,2010,18(4):455-459.
32 Sirsi D,Safdieh JE.The safety of levetiracetam.Expert Opin Drug Saf,2007,6(3):241-250.
33 Verrotti A,Prezioso G,Di Sabatino F,et al.The adverse event profile of levetiracetam:A meta-analysis on children and adults.Seizure,2015,31:49-55.
34 Chen B,Choi H,Hirsch LJ,et al. Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy.Epilepsy Behav,2017,76:24-31.
35 Cramer JA,De Rue K,Devinsky O,et al. A systematic review of thebehavioral effects of levetiracetam in adults with epilepsy,cognitive disorders,or an anxiety disorder during clinical trials.Epilepsy Behav,2003,4(2):124-132.
36 Nickel C,Lahmann C,Tritt K,et al.Topiramate in treatment of depressive and anger symptoms in female depressive patients:a randomized,double-blind,placebo-controlled study.J Affect Disord,2005,87(2-3):243-252.
37 Carpenter LL,Leon Z,Yasmin S,et al. Do obese depressed patients respond to topiramate? A retrospective chart review.J Affect Disord,2002,69(1-3):251-255.
38 Hussain MZ,Chaudhry ZA.Topiramate in treatment of refractory bipolar depression.J Affective disorders and antidepressants,2002,3:199-200.
39 Boylan LS,Devinsky O,Barry JJ,et al.Psychiatric uses of antiepileptic treatments.Epilepsy Behav,2002,3(5S):54-59.
40 Drane DL,Meador KJ.Cognitive and behavioral effects of antiepileptic drugs.Epilepsy Behav,2002,3(5S):49-53.
41 Dussaule C,Bouilleret V.Psychiatric effects of antiepileptic drugs in adults.Geriatr Psychol Neuropsychiatr Vieil,2018,16(2):181-188.
42 Eddy CM,Rickards HE,Cavanna AE.Behavioral adverse effects of antiepileptic drugs in epilepsy.J Clin Psychopharmacol,2012,32(3):362-375.
43 Tzitiridou M,Panou T,Ramantani G,et al.Oxcarbazepine monotherapy in benign childhood epilepsy with centrotemporalspikes:a clinical and cognitive evaluation.Epilepsy Behav,2005,7(3):458-467.
44 Biton V,Shneker BF,Naritoku D,et al. Long-term tolerability and safety of lamotrigine extended-release:pooled analysis of three clinical trials.Clin Drug Investig,2013,33(5):359-364.
45 Jain SV,Glauser TA.Effects of epilepsy treatments on sleep architecture and daytime sleepiness:an evidence-based review of objective sleep metrics.Epilepsia,2014,55(1):26-37.
46 Vaughn BV,D'Cruz OF.Sleep and epilepsy.Semin Neurol,2004,24(3):301-313.
47 Shen Y,Zhang M,Wang Y,et al.Subjective sleep disturbance in Chinese adults with epilepsy:associations with affective symptoms.Epilepsy Res,2017:135150-157.
48 Foldvary N,Perry M,Lee J,et al. The effects of lamotrigine on sleep in patients with epilepsy.Epilepsia,2001,42(12):1569-1573.
49 Jabbehdari S,Hesami O,Chavoshnejad M.Prevalence of Migraine Headache in Epileptic Patients.Acta Med Iran,2015,53(6):373-375.
50 Wang XQ,Lang SY,Zhang X.Comorbidity between headache and epilepsy in a Chinese epileptic center.Epilepsy Res,2014,108(3):535-541.
51 Ottman R,Lipton RB.Is the comorbidity of epilepsy and migraine due to a shared genetic susceptibility?Neurology,1996,47(4):918-924.