臨床神経学

<シンポジウム(2)―4―5>臨床てんかん学の最近の診断と治療の最前線

てんかんにともなう精神症状・心因性発作への対処

兼本 浩祐, 田所 ゆかり, 大島 智弘

愛知医科大学精神科学講座〔〒480―1195 長久手市岩作雁又1―1〕

Almost every kind of psychiatric problems are associated with epilepsy such as psychotic states, manic as well as depressive states and anxiety attacks. Overall, the prevalence of psychiatric comorbidities in patients with epilepsy amounts to as high as 20-30% of all cases. Acute and chronic interictal psychoses, as well as postictal psychosis (or more precisely periictal psychosis), comprise 95% of psychosis in patients with epilepsy. Prevalence of depressive states in patients with yet active epilepsy ranges from 20-55%. Prevalence in patients with controlled epilepsy ranges from 3-9%. Depressive states comprise 50-80% of psychiatric co-morbidities in patients with epilepsy. Several studies reported that PNES amounted to as high as 30% among patients considered as candidates for epilepsy surgery due to intractable epilepsy. It is of clinical use that PNES is divided into 3 groups: The first group belongs to PNES without either intellectual disability nor epilepsy; The second group suffers from intellectual disability in addition to PNES; The third group shows both epileptic seizure and PNES. These groups need to be differently treated. After temporal lobectomy for controlling pharmacoresistant TLE, severe but transient depression possibly leading to suicide can appear, especially within the first few months after surgery.
Full Text of this Article in Japanese PDF (244K)

(臨床神経, 52:1091−1093, 2012)
key words:てんかん,うつ状態,精神病,心因性非てんかん性発作

(受付日:2012年5月24日)