Analysis Of Related Factors For Depression In Patients With Post-stroke Epilepsy And Study On The Treatment Of Citalopram

BackgroundWith the increasing incidence of stroke,it has become the leading cause of disability and death among adults in China,and post-stroke epilepsy has also become the most common symptomatic epilepsy among adults.The patients with post-stroke epilepsy have nervous system dysfunction and recurrent epileptic seizures.In addition,as the patients have taken antiepileptic medicine for a long time,it is easy to occur mental disorders,and resulting in increased suicide rate and mortality,causing family and society a serious burden,we should attach great importance to it.So,we systematically investigated the status and related factors of post-stroke epilepsy with depression in our hospital,and observed the efficacy of antidepressant citalopram on post-stroke epilepsy with depression in order to provide a reliable theoretical basis for clinical treatment.Citalopram is a selective serotonin reuptake inhibitor,which can increase the function of the serotonin nerve and reduce the depression symptoms and incidence of patients.The medicine has few adverse reactions,is not easy to interact with other medicines.And the medicine can improve sleep quality,and resist anxiety.Thus the medicine is suitable for patients with physical complications or elderly people,and is an appropriate choice for patients with post-stroke epilepsy and comorbid depression.The current study shows that citalopram can not only improve depressive symptoms,but also increase blood supply to focus and promote nerve repair through serotonin action on the nervous system,improve nervous system symptoms and reduce epileptic seizures.However,there are few reports of citalopram for patients with post-stroke epilepsy and comorbid depression.This subject is mainly concerned with post-stroke epilepsy patients with a stroke duration of more than one month.The stroke of these patients tends to be stable,often discharged and gone,and their depression is easily overlooked.It is especially necessary to conduct in-depth research on such patients and to give appropriate treatment.Objective1.To evaluate the current state of depression of post-stroke epilepsy and study related factors of depression in them.2.To observe the effect of citalopram on the mental symptoms of patients with post-stroke epilepsy and comorbid depression,the improvement of neurological function,cognitive impairment and ability of daily living,the impaction on epileptic seizures and their safety.Methods1.Investigation of depression status and related factors in patients with epilepsy after stroke:(1)144 patients with post-stroke epilepsy(suffering from stroke for more than 1 month)were randomly collected from the outpatient department and inpatient department of neurology in our hospital from November 1,2013 to October 31,2017.Among them,there were 76 males and 68 females.Similar baseline data of 158 stroke patients were collected at the same time,with 84 males and 74 females as controls.Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to score and assess the depression status of patients.(2)The demographic characteristics of 144 patients with post-stroke epilepsy(including gender,age,education background,marital status),risk factors of stroke(smoking,drinking,hypertension,diabetes,obesity,heart disease,dyslipidemia),clinical characteristics and treatment(including type of stroke,lesion location of stroke,epileptic seizure type,seizure frequency,and seizure form,course of disease and medication),relevant test indicators(including homocysteine,serum brain-derived nutritional factors,serum DA,5-HT),polymorphism of serotonin transporter gene(5-HTT LPR)and neurological deficit(NIHSS score),cognitive dysfunction(MMSE score)and self-care impairment(BI index)were also analyzed to systematically study the related factors of post-stroke epilepsy and comorbid depression.2.The results of first part showed that 84 of 144 patients with post-stroke epilepsy comorbid depression.And we selected 82 patients according to the inclusion criteria from these 84 patients.Then 82 patients with post-stroke epilepsy comorbid depression were randomly divided into two groups include treatment group(42 cases)and control group(40 cases).The treatment group was given citalopram combined with routine treatment of stroke and antiepileptic medicine for 12 weeks.The control group was given placebo combined with routine treatment of stroke and antiepileptic medicine for 12 weeks.The changes of laboratory indexes(HCY,BDNF,DA,5-HT)and scale scores(HAMD,HAMA,NIHSS,MMSE,BI)before treatment,4 weeks after treatment and 12 weeks after treatment were observed to evaluate the efficacy and safety.ResultsThe results of the investigation of depression status and related factors in patients with epilepsy after stroke:(1)The HAMD score of the post-stroke epilepsy group was 22.54± 13.87,which was significantly higher than that of the simple stroke group by 16.64 ± 11.38(P<0.01).The HAMD score ?20 was divided into depression.The post-stroke epilepsy group had a depression status of 84(58.33%),which was significantly higher than that of the simple stroke group 62(36.24%).Among depression,14(16.67%)had severe depression(HAMD ? 35),6(7.14%)had suicidal tendency,and 64(76.19%)had depression and anxiety comorbidities,which were higher than those in the stroke group.(2)The post-stroke epilepsy group had different rates of hypertension,diabetes,obesity,seizure type,seizure frequency,lesion location,course of disease,and medications(P<0.05).And their distribution in the depression group and non-depression group was different(P<0.05),and their difference in HAMD total score was statistically significant(P<0.05).For these factors:gender,age,education,marital status,smoking,alcohol,heart disease,hyperlipidemia,and pathogeny(hemorrhagic and ischemic),there was no significant difference in the incidence of depression,distribution and the HAMD score between the depression group and the non-depression group(P>0.05).The level of Hcy in the depression group was higher than that in the non-depression group(P<0.05),and the BDNF and 5-HT were lower than those in the non-depression group(P<0.05).There was a statistically significant differences.The DA level was slightly lower than that in then on-depression group,but there was no statistically differences(P>0.05).The frequency of serotonin transporter genotype SS and allele S in the depression group were higher than those in the non-depressed group,and the frequency of genotype LL and allele L were significantly lower than those in the non-depressed group(P<0.05).The HAMD score,HAMA score and NIHSS score of the depression group were higher than those of the non-depression group,and the MMSE score and BI index were lower than those of the non-depression group(P<0.05).(3)Correlation analysis shows:The patient's depression status was related to diabetes,obesity,lesion site,course of disease,epileptic seizures type,seizure frequency,BDNF,5-HT,5-HTTLPR genotype SS and LL,HAMA score,NIHSS score,MMSE score and BI index.Multiple stepwise regression showed that obesity,seizure frequency,NIHSS score and HAMA score were risk factors for depression in post-stroke epilepsy patients,5-HT level and BI score were protection factors.2.The results of therapeutic effect of citalopram on patients with epilepsy and comorbid depression after stroke:(1)Comparison of results of treatment group and control group before and after treatment.Comparison of Clinical lab index:In the treatment group after treatment for 4 weeks,only 5-HT content was higher than that before treatment(P<0.05).In the treatment group,after treatment for 12 weeks,the Hcy content was lower than that before treatment(P<0.05),and was lower than the control group(P<0.05)over the same period;the BDNF content was significantly higher than before treatment(P<0.01),and higher than the control group(P<0.05)over the same period;the 5-HT content was significantly higher than before treatment(P<0.01),and significantly higher than the same period of control(P<0.01)over the same period;the DA content was higher than that before the treatment and the control group,but the difference was not statistically significant(P>0.05).In the control group,only BDNF content after treatment for 12 weeks,was higher than that before treatment(P<0.05).There was no significant difference in index changes between the other groups(P>0.05).Comparison of seizure frequency:In the treatment group,the epileptic seizures frequency(2.83 ± 2.08)after 12 weeks of oral citalopram treatment was significantly lower than that before treatment(4.82 ±4.13)(P<0.01),and significantly lower than that of the control group(4.12±3.17)(P<0.01)over the same period.Comparison of The HAMD score:In the treatment group after 4 weeks the HAMD score(21.17 ±9.38)was lower than that before treatment(26.62 ± 11.42)(P<0.05),and 12 weeks later(14.72 ± 9.83)was significantly lower than before treatment(26.62 ±11.42)(P<0.01).),and significantly lower than the control group(23.98 ± 10.75)(P<0.01)over the same period.There was no significant difference in scale scores changes between the other groups(P>0.05).Comparison of other scales:In the treatment group,the HAMA score of the treatment group after 4 weeks was lower than that before treatment(P<0.05),and 12 week later the score was significantly lower than that before treatment(P<0.01),and significantly lower than the control group(P<0.01)over the same period.The NIHSS score of the treatment group after 12 weeks was lower than that before treatment(P<0.05),and was lower than the control group(P<0.05)over the same period.The MMSE score of the treatment group after 12 weeks was higher than that before treatment(P<0.05),and was higher than the control group(P<0.05)over the same period.The BI index of the treatment group after 12 weeks was significengt higher than that before treatment(P<0.01,and was significant higher than the control group(P<0.01)over the same period.The BI index of the control group after 12 weeks was significengt higher than that before treatment(P<0.05).There was no significant difference in scale scores changes between the other groups(P>0.05).Correlation of the change of test indexes,the frequency of seizures and scales:The changes of BDNF,5-HT,the frequency of seizures,HAMA and BI index score in the two groups after treatment at 12 weeks and before treatment were the influencing factors of depression.The changes of 5-HT,HAMD score,HAMA score and NIHSS score were the influencing factors of the frequency of epileptic seizure.(3)Only a few patients with citalopram treatment showed mild adverse reactions(eg nausea,dry mouth,constipation,sweating,etc.),which was safe.Conclusions1.The incidence of depression in post-stroke epilepsy patients is higher than that in stroke patients,and the incidence of major depression,suicidal tendency and anxiety and depression comorbidity is higher.Depression status of patients was related to diabetes,obesity,lesion location,course of disease,type of seizure,frequency of seizures,concentration of BDNF,5-HT concentration,5-HTTLPR genotype SS and LL,HAMA score,NIHSS score,MMSE score,BI index.Among them,obesity,seizure frequency,NIHSS score and HAMA score were risk factors for depression in post-stroke epilepsy patients.5-HT level and BI index were protective factors.2.Citalopram can not only improve the mental symptoms,neurological dysfunction,cognitive dysfunction and daily living ability of patients with epilepsy after stroke and comorbid depression,but also reduce the frequency of epileptic seizures,and it has good security.