外部情绪对原发性癫痫伴发抑郁情绪患者脑电活动的影响

发布时间：2018-08-09 19:43

【摘要】：背景：癫痫是神经系统常见的慢性疾病。癫痫和抑郁共病早已引起神经精神科专家的关注。10%～20%发作已经得到控制的癫痫患者和20%～60%发作未得到控制的癫痫患者存在抑郁障碍。有抑郁病史的人更易发展为癫痫，是无抑郁史的人的4～6倍。癫痫和抑郁对于患者的生活质量的影响极为严重，所以癫痫伴发抑郁的诊断、治疗及发作的预防对于患者生理、心理及患者家庭生存状态就显得极为重要。癫痫和抑郁具有相同的发病机制和病因。研究表明癫痫发作持续时间以及抑郁严重程度呈负相关。我们推测负性情绪刺激对癫痫伴发抑郁患者的癫痫发作具有重要的意义，负性事件作为一种刺激可能诱发和/或加重癫痫伴发抑郁情绪患者的癫痫发作。癫痫伴发抑郁患者的负性刺激的脑电图变化，目前尚不明确。目的：探讨原发性癫痫伴发抑郁情绪患者在受到负性面部表情刺激时脑电波的变化，，以期对原发性癫痫伴发抑郁情绪患者诊断和治疗提供临床依据。方法：本研究纳入15例癫痫伴发抑郁情绪组、6例癫痫不伴抑郁情绪组和8例正常对照组。分别对三组受试者采用成人癫痫生活质量量表（QOLIE-31）进行生活质量调查。记录并比较受试者在接受中性面部表情刺激、正性面部表情刺激和负性面部表情刺激时的脑电图变化。结果：癫痫发作频率与HAMD分数之间正相关，原发性癫痫患者抑郁程度与癫痫发作频率呈显著正相关性（0.610，P=0.003）。与正常对照组或原发性癫痫不伴抑郁组相比较，原发性癫痫伴发抑郁组患者的QOLIE-31评分明显降低（P分别0.05）。癫痫患者EEG慢波数量与HAMD评分之间呈正显著相关性（r=0.479，P=0.044）。三种面部表情刺激下，正常对照组或癫痫不伴抑郁组慢波数量均无明显变化（P分别＞0.05）。与接受中性面部表情刺激时相比，癫痫伴发抑郁组接受负性表情刺激时脑电图出现慢波数明显增多（P分别0.05）。结论：原发性癫痫伴发抑郁时的慢波活动增多可能导致癫痫患者发作阈值的降低，预示癫痫发作的风险也明显增加。有必要早期识别癫痫伴发抑郁的患者并给与及时治疗。接受负性面部表情刺激时患者的慢波数量明显多于接受中性面部表情刺激时，提示负性刺激可能增加甚至诱发原发性癫痫伴发抑郁患者的癫痫发作，可以此为根据对患者的日常生活进行合理指导以减少发作，从而提高生活质量。
[Abstract]:Background: epilepsy is a common chronic disease of the nervous system. Epileptic and depressive syndromes have attracted the attention of neuropsychiatrists for a long time. 20% of epileptic patients with controlled seizures and 20% of uncontrolled epileptic patients have depression disorders. People with a history of depression were more likely to develop epilepsy than people without a history of depression. The influence of epilepsy and depression on the quality of life of patients is very serious, so the diagnosis, treatment and prevention of epilepsy accompanied with depression are very important for the physiological, psychological and family living state of the patients. Epilepsy and depression have the same pathogenesis and etiology. Studies have shown a negative correlation between the duration of seizures and the severity of depression. We speculate that negative emotional stimulation plays an important role in epileptic seizures in patients with epilepsy and depression. As a kind of stimulation, negative events may induce and / or aggravate epileptic seizures in patients with epilepsy associated with depression. The EEG changes of negative stimuli in epileptic patients with depression are unclear. Objective: to investigate the changes of brain waves in patients with primary epilepsy accompanied with depression when stimulated by negative facial expressions in order to provide clinical basis for the diagnosis and treatment of patients with primary epilepsy accompanied with depression. Methods: 15 epileptic patients with depression were enrolled in this study, 6 patients with epilepsy without depression and 8 normal controls. Adult Epilepsy quality of Life scale (QOLIE-31) was used to investigate the quality of life in three groups. EEG changes were recorded and compared with neutral facial stimulation, positive facial stimulation and negative facial stimulation. Results: there was a positive correlation between epileptic seizure frequency and HAMD score. There was a significant positive correlation between depressive degree and epileptic seizure frequency in patients with primary epilepsy (0.610 P0. 003). The QOLIE-31 scores of patients with primary epilepsy and depression were significantly lower than those of normal controls or patients with primary epilepsy without depression (P 0.05, respectively). There was a positive correlation between the number of EEG slow waves and the HAMD score in epileptic patients (r = 0.479 / P = 0.044). There was no significant change in the number of slow wave in normal control group or epileptic without depression group under three facial expressions (P > 0.05). Compared with those receiving neutral facial expression stimulation, the number of slow waves of EEG in epileptic patients with depression was significantly higher than that in patients with depression (P 0.05, respectively). Conclusion: the increase of slow wave activity in patients with primary epilepsy associated with depression may lead to the decrease of seizure threshold and the increased risk of epileptic seizures. It is necessary to identify and treat patients with epilepsy associated with depression at an early stage. The number of slow waves in patients receiving negative facial expression stimulation was significantly higher than that in neutral facial expression stimulation, which suggested that negative stimulation might increase or even induce epileptic seizures in patients with primary epilepsy and depression. It can be used as the basis for reasonable guidance of patients' daily life in order to reduce seizures and improve the quality of life.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.1;R749.4

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