【摘要】：背景：癲癇是神經(jīng)系統(tǒng)常見的慢性疾病。癲癇和抑郁共病早已引起神經(jīng)精神科專家的關(guān)注。10%～20%發(fā)作已經(jīng)得到控制的癲癇患者和20%～60%發(fā)作未得到控制的癲癇患者存在抑郁障礙。有抑郁病史的人更易發(fā)展為癲癇，是無抑郁史的人的4～6倍。癲癇和抑郁對(duì)于患者的生活質(zhì)量的影響極為嚴(yán)重，所以癲癇伴發(fā)抑郁的診斷、治療及發(fā)作的預(yù)防對(duì)于患者生理、心理及患者家庭生存狀態(tài)就顯得極為重要。癲癇和抑郁具有相同的發(fā)病機(jī)制和病因。研究表明癲癇發(fā)作持續(xù)時(shí)間以及抑郁嚴(yán)重程度呈負(fù)相關(guān)。我們推測(cè)負(fù)性情緒刺激對(duì)癲癇伴發(fā)抑郁患者的癲癇發(fā)作具有重要的意義，負(fù)性事件作為一種刺激可能誘發(fā)和/或加重癲癇伴發(fā)抑郁情緒患者的癲癇發(fā)作。癲癇伴發(fā)抑郁患者的負(fù)性刺激的腦電圖變化，目前尚不明確。 目的：探討原發(fā)性癲癇伴發(fā)抑郁情緒患者在受到負(fù)性面部表情刺激時(shí)腦電波的變化，，以期對(duì)原發(fā)性癲癇伴發(fā)抑郁情緒患者診斷和治療提供臨床依據(jù)。 方法：本研究納入15例癲癇伴發(fā)抑郁情緒組、6例癲癇不伴抑郁情緒組和8例正常對(duì)照組。分別對(duì)三組受試者采用成人癲癇生活質(zhì)量量表（QOLIE-31）進(jìn)行生活質(zhì)量調(diào)查。記錄并比較受試者在接受中性面部表情刺激、正性面部表情刺激和負(fù)性面部表情刺激時(shí)的腦電圖變化。 結(jié)果：癲癇發(fā)作頻率與HAMD分?jǐn)?shù)之間正相關(guān)，原發(fā)性癲癇患者抑郁程度與癲癇發(fā)作頻率呈顯著正相關(guān)性（0.610，P=0.003）。與正常對(duì)照組或原發(fā)性癲癇不伴抑郁組相比較，原發(fā)性癲癇伴發(fā)抑郁組患者的QOLIE-31評(píng)分明顯降低（P分別0.05）。癲癇患者EEG慢波數(shù)量與HAMD評(píng)分之間呈正顯著相關(guān)性（r=0.479，P=0.044）。三種面部表情刺激下，正常對(duì)照組或癲癇不伴抑郁組慢波數(shù)量均無明顯變化（P分別＞0.05）。與接受中性面部表情刺激時(shí)相比，癲癇伴發(fā)抑郁組接受負(fù)性表情刺激時(shí)腦電圖出現(xiàn)慢波數(shù)明顯增多（P分別0.05）。 結(jié)論：原發(fā)性癲癇伴發(fā)抑郁時(shí)的慢波活動(dòng)增多可能導(dǎo)致癲癇患者發(fā)作閾值的降低，預(yù)示癲癇發(fā)作的風(fēng)險(xiǎn)也明顯增加。有必要早期識(shí)別癲癇伴發(fā)抑郁的患者并給與及時(shí)治療。接受負(fù)性面部表情刺激時(shí)患者的慢波數(shù)量明顯多于接受中性面部表情刺激時(shí)，提示負(fù)性刺激可能增加甚至誘發(fā)原發(fā)性癲癇伴發(fā)抑郁患者的癲癇發(fā)作，可以此為根據(jù)對(duì)患者的日常生活進(jìn)行合理指導(dǎo)以減少發(fā)作，從而提高生活質(zhì)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R742.1;R749.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王藝,張劍英,孫道開;復(fù)雜部分性癲癇持續(xù)狀態(tài)的臨床與腦電圖特征[J];中國(guó)當(dāng)代兒科雜志;2000年01期

2 李六一;;癲vN患者抑郁情緒及其事件相關(guān)電位研究[J];中華實(shí)用診斷與治療雜志;2009年02期

3 向代群,徐鴻儒,周東;癲癇患者抑郁障礙研究[J];華西醫(yī)學(xué);1998年01期

4 楊春霞;沈維英;杜巧榮;付永毅;于宏春;左麗娜;王艷;張克讓;;首發(fā)抑郁癥患者與正常對(duì)照認(rèn)知功能的比較研究[J];上海精神醫(yī)學(xué);2009年03期

5 謝利軍;唐啟盛;霍愛榮;;隱匿抑郁癥患者腦電特點(diǎn)分析[J];北京中醫(yī)藥大學(xué)學(xué)報(bào)(中醫(yī)臨床版);2006年06期

6 劉洪濤;;樂源誘發(fā)癲癇1例[J];臨床心身疾病雜志;2008年04期

7 魯在清,劉娟;初次腦電圖檢查異常慢波對(duì)癲沲診斷的影響[J];臨床神經(jīng)電生理學(xué)雜志;2003年02期

8 張澤芝;吳懼;牟啟蓉;;小兒擬診癲沲152例的剝奪睡眠腦電圖分析[J];臨床神經(jīng)電生理學(xué)雜志;2008年05期

9 朱俊玲,林宏,宿長(zhǎng)軍,沈強(qiáng),蔣大宗;小波能量評(píng)價(jià)EEG的不同成分對(duì)癲癇發(fā)作預(yù)報(bào)的價(jià)值[J];生物物理學(xué)報(bào);2003年01期

10 袁勇貴,吳愛勤,張心保,李樂加;焦慮和抑郁障礙共病的腦電地形圖研究[J];中國(guó)行為醫(yī)學(xué)科學(xué);2003年02期

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