以抑郁症症状为首发症状的癫痫发作

Depressive symptoms as the first manifestation of epilepsy

文献报道,抑郁症症状可以成为癫痫的发作症状,但是不是癫痫独立的或首发的尚不清楚。我们回顾性分析了5例以抑郁为首发症状的单纯癫痫。所有患者的神经系统检查、脑脊液检查、磁共振检查均正常,可排除脑部器质性病变。全部患者首诊经精神科医生诊断为抑郁症,其中3例为中度抑郁,1例为重度抑郁。所有患者的随机脑电图检查均显示轻度异常,后经24小时动态脑电图监测,确诊为癫痫的复杂部分发作。予以卡马西平或者拉莫三嗪治疗后情绪正常,也无其它形式癫痫发作,多次脑电图检查显示恢复正常。随访8～18月无发作。因此,我们认为抑郁症症状可以是癫痫发作的首发表现,而诊断"功能性的"抑郁症则一定要排除以抑郁症状为首发症状的癫痫发作。

Objective Some research has shown that depressive symptoms can be the manifestation of the seizures of epilepsy. However,it is not clear whether the depressive symptoms are the first or the independent clinical manifestations of epilepsy. Therefore,we retrospectively analysed five cases of epilepsy who depressive symptoms were presented as the first symptom. Depressive disorders （including 3 moderate and 1 severe） were confirmed by two psychiatrists according to current DSM-4 criteria in the 5 patients. The neurological,MRI and cerebral spinal fluid examinations were normal in the 5 patients. They were confirmed with complex partial seizures by 24 hours electroencephalogram （EEG）. After carbamazepine or lamotrigine treatment,the five patients completely recovered from depressive disorders and had any other clinical seizures of epilepsy,with normal EEG findings. All patients were followed up for 8 to 18 months and they were seizure-free. It was concluded that the symptoms of depressive disorders can be as the first clinical manifestation of epilepsy,suggesting that before the diagnosis of ＂functional＂ depressive disorders is made,epilepsy should be excluded.