| Part 1 The trajectories of psychiatric symptoms and its influencing factors in patients with newly diagnosed epilepsyObjective:To identify trajectories of depressive and anxiety symptoms during 12 months period after newly diagnosed epilepsy,and investigate whether the trajectories of psychiatric symptoms are affected by seizure outcome,including seizure recurrence and the number of ASMs.Methods:A total 232 patients with newly diagnosed epilepsy were consecutively included.Data were collected using a designed information questionnaire.Psychiatric evaluations were performed at baseline,6-month follow-up and 12-month follow-up interviews.The trajectories of depressive and anxiety symptom scores over three time points were identified.The factors affecting the trajectories of psychiatric symptoms were analyzed using the the generalized linear mixed model.Results:Depression and anxiety trajectories were identified.The NDDI-E depressive scores over three time points showed a downward trend,with significant differences.Similarly,the trajectories of GAD-7 anxiety scores showed a downward trend,with significant differences.The factors affecting depression trajectories included gender,age at onset,seizure recurrence and the number of ASMs.Gender,seizure recurrence and the number of ASMs were the influencing factors of the anxiety trajectories.Conclusion:Depressive and anxiety symptoms are more serious at baseline in patients,and then gradually improved at 6-momth and 12-month follow-up interviews.Depression and anxiety trajectories show a downward trend.The trajectories of psychiatric symptoms are affected by seizure recurrence and the number of ASMs.Part 2 The impacts of psychiatric comorbidities at baseline on seizure recurrence and prediction model for seizure recurrence in newly treated patients.Objective:To examine whether psychiatric comorbidity at baseline is a predictor of seizure recurrence in newly treated patients,and to develop and validate a prediction model for seizure recurrence utilizing readily available routine clinical variables.Methods:The prospective cohort study was performed in Northeast China.Participants were divided into two different cohorts(development cohort and validation cohort)according to the ratio of 7:3.Logistic regression analysis was used to determine the impact of psychiatric comorbidity at baseline on seizure recurrence based in the development cohort.A clinical prediction model was developed in development cohort and validated with data in validation cohort after development.Results:A clinical prediction model was developed with individual patient data from 589 patients(development cohort)and validated with data from 247 patients(validation cohort)after development.In the development cohort,psychiatric comorbidity at baseline was a predictor of seizure recurrence.Additionally,sex/menstrual epilepsy(male vs.female/menstrual epilepsy),>5 seizures before treatment,brain MRI lesion,and EEG epileptiform discharge burdens were all associated with the risk of seizure recurrence.Based on these predictors,we developed a multivariable model that had good discrimination with an area under the receiver operator characteristics curve(AUC)of 0.801.The calibration plot showed that the prediction model fit well with the observations.In the validation cohort,this model also showed good discrimination and satisfactory calibration.Conclusion:Comorbid anxiety and depression at baseline are predictors of seizure recurrence in newly treated patients.The prediction model used 6 predictive variables to calculate the individual risk of seizure recurrence in newly treated patients.The estimates can help guide patients and clinicians in making individually tailored choices,which may influence the intensity of the ASM dose adjustment strategy.Part 3 Psychiatric comorbidities predict drug-resistant epilepsy in patients with newly diagnosed epilepsy.Objective:Literature on the complex relationships between psychiatric comorbidities and drug resistance in newly treated patients with epilepsy is lacking.We aimed to determine whether psychiatric comorbidities at baseline are predictive of the development of drug-resistant epilepsy(DRE)in newly treated patients.Methods:Newly treated patients with epilepsy were psychiatrically evaluated at enrolment and were followed for 24 months to determine the occurrence of drug-resistant epilepsy.The impacts of comorbid depression and anxiety on the development of drug-resistant epilepsy were investigated using the univariate and multivariate Cox proportional hazard model.Other predictors of drug-resistant epilepsy were also identified.We establish a simple scoring system for predicting drug-resistant epilepsy based on the Cox analysis results.Results:A total of 738 newly diagnosed epilepsy patients were included in the final analysis.At baseline,25.5%of the patients were diagnosed with comorbid depression and 35.6%were diagnosed with comorbid anxiety.During the 24-month follow-up period,216 patients(29.3%)developed drug-resistant epilepsy.Multivariate Cox proportional hazard analysis showed that comorbid anxiety and depression at baseline were independent predictors of drug-resistant epilepsy.The risk of developing drug-resistant epilepsy in patients with comorbid anxiety and depression was 4.469 times higher than that in patients without comorbid anxiety or depression.In addition,more than 5 seizures and brain MRI lesions before treatment were also independent predictors of drug-resistant epilepsy.In the simple scoring system,the risk of developing drug-resistant epilepsy in patients with a score of 4 is 17.783 times higher than that in patients with a score of 0.Conclusion:The psychiatric comorbidities at baseline provide prognostic information for the development of drug-resistant epilepsy in newly treated patients.Our findings provide a new direction for future research.It is worth paying attention to whether the intervention on psychiatric comorbidities at baseline can reduce the risk of developing drug-resistant epilepsy in patients. |
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