| BackgroundEpilepsy(EP)is a common chronic disease of the nervous system.The seizure of epilepsy is uncertain,the condition is easy to relapse,and the patients need to take antiepileptic drugs for a long time.It brings great psychological pressure to patients.To this extent,they are still subject to social discrimination,misunderstanding,and having a sense of social stigma.Therefore,patients with epilepsy often have different degrees of psychological disorders.In recent years,epilepsy complications have attracted much attention,among which the most common is depression and anxiety.In many studies,the incidence of epilepsy combined with depression and anxiety is significantly higher than that of the general population.Its clinical manifestations are diverse and there are many influencing factors.Further study and summary of clinical data and analysis of clinical characteristics are undoubtedly helpful for the early diagnosis and treatment of epilepsy patients.The pathogenesis of epilepsy combined with depression/anxiety is not fully established.In recent years,neurotrophic factors and inflammatory cytokines have attracted much attention in the research of epilepsy with affective disorders.Brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF)are members of the neurotrophic factor family,which are involved in neuron protection,synapse reconstruction and regeneration,and nerve functional reconstruction after injury.The plasticity and reconstruction of synapse play an important role in the pathogenesis of depression and anxiety.Inflammatory factors interleukin-1β(IL-1β)and interleukin-6(IL-6)have been confirmed to be involved in the occurrence of depression and anxiety.The inflammatory factors interleukin-1β(IL-1β)and interleukin-6(IL-6)have been shown to be related with the development of depression and anxiety.Inflammatory cytokines IL-1βand IL-6 are also detected in animal models of epilepsy,and elevated plasma IL-1βlevels are specifically associated with seizure-related depression.However,in recent years,different studies at home and abroad have paid more and more attention to focus on the changes in serum cytokine levels in epilepsy complicated with depression and anxiety.Through these changes,they want to find concise and sensitive indicators,timely detect patients with epilepsy combined with depression and anxiety,timely give clinical intervention,enhance the treatment effect and improve the quality of life.ObjectiveThrough the clinical analysis of epilepsy patients,this study explores the possible influencing factors of epilepsy combined with depression and anxiety,common clinical manifestations and therapeutic effects.By measuring serum levels of BDNF,NGF,IF1-β and IF-6 of the epilepsy patients with depression/anxiety disorder and epilepsy patients without depress ion/anxiety disorder,we explore the relationship between depression and anxiety status of epilepsy patients and the above-mentioned serum cytokine levels.This helps early diagnosis and treatment.MethodsAccording to consistent standards,we collected 146 epilepsy patients who were admitted to Shandong University Qilu Hospital.After signing the informed consent,we performed the Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)for patients.According to the evaluation results,there were 45 cases(Including 3 people only with depression disorder,2 people only with anxiety disorder,and 40 people concomitant depression and anxiety disorder)of epilepsy combined with depression/anxiety which are classified as epilepsy with depression/anxiety disorder,and 101 patients with epilepsy without depression/anxiety served as control group.Symptomatic characteristics of epilepsy patients with depression and anxiety disorder were summarized through detailed statistics of the social demographic characteristics and characteristics of epilepsy itself in the two groups.Patients with severe depression/anxiety disorders were treated with escitalopram and prognosis was observed.Peripheral venous blood was collected under fasting state to obtain serum samples of the experimental group and the control group,and then Enzyme linked immunosorbent assay(ELISA)was used to determine serum levels of BDNF,NGF,IF1-β and IF-6.Statistical software SPSS 26.0 was used to analyze whether there was statistical difference between the groups,analyze the correlation between the demographic characteristics of epileptic patients with depression,anxiety and affective disorder and the related factors of epileptic seizures.and explore the relationship with changes in serum cytokine levels.ResultsStatistical analysis of the two groups of data showed that the incidence of epilepsy combined with depression and anxiety was 30.82%,and the proportion of epilepsy without depression and anxiety was 69.18%.Univariate analysis showed that the education level,the duration of epilepsy,the type of seizures,the average number of attacks per month in the first 3 months of enrollment,and the lesion loca,tion were the risk factors of epilepsy with depression and anxiety(P<0.05).Multivariate analysis showed that the duration of epilepsy,the average number of seizures per month in the first three months,the location of lesions and other factors were independent risk factors of depression and anxiety(P<0.05).The most common clinical manifestations of epilepsy combined with depression were sleep disorders and slow thinking,accounting for 81.4%,followed by depression,accounting for 76.7%.Guilt,loss of interest in work,mental anxiety,somatic anxiety and systemic symptoms accounted for more than 50%respectively.Anxious mood is the most common clinical manifestation of epilepsy combined with anxiety disorder,whose incidence rate is as high as 83.3%.And tension and cognitive impairment ranked second,accounting for 81.0%.Insomnia and dreaminess,depressive mood and other symptoms were also more common,accounting for more than 50%respectively.By independent sample t-test comparison,the serum BDNF level of the experimental group(1.47 0.93ng/ml)was lower than that of the control group(2.03 1.00 ng/ml,P<0.05);The serum NGF level of the experimental group(34.04 27.28pg/ml)was lower than that of the control group(44.62 36.63pg/ml,P=0.042);The level of serum inflammatory factor IL-6 in experimental group(16.73 9.15pg/ml)was significantly higher than that in control group(11.48 9.53pg/ml,P<0.05);The level of IL-1β in peripheral blood of the experimental group was(11.97±2.03pg/ml)Was higher than in the control group(5.88±1.15pg/ml).Pearson correlation analysis showed that serum BDNF level in the epilepsy with depression/anxiety group was negatively correlated with HAMD score(r=-0.422,p<0.05)and HAMA score(r=-0.390,p<0.05).The level of IL-1β was positively correlated with HAMD score(r=0.354,p<0.05)and HAMA score(r=-0.362,p<0.05).IL-6 level was positively correlated with HAMD score(r=0.439,p<0.05)and HAMA score(r=0.396,p<0.05).There is no significant correlation between NGF and HAMD score(r=0.035,p>0.05)and HAMA score(r=-0.072,p>0.05).After taking escitalopram(10-20mg/per day)for 3-6 months,the scores of HAMD(12.44±2.60)and HAMA(13.13±1.96)after taking escitalopram were significantly lower than those before taking escitalopram(22.78±1.48,P<0.05 and 21.75±2.25,P<0.05).Conclusions1.The education level,the duration of epilepsy,the type of seizures,the average number of attacks per month in the first 3 months of enrollment,and the lesion location(Whether it is temporal lobe epilepsy)were the risk factors of epilepsy with depression/anxiety.The duration of epilepsy,the average number of seizures per month in the first three months,the location of lesions(Whether it is temporal lobe epilepsy)and other factors were independent risk factors of depression and anxiety.2.The main clinical manifestations of epilepsy accompanied by depression were sleep disturbance,sluggish and depression.The main clinical manifestations of patients with epilepsy accompanied by anxiety state are anxiety mood cognitive dysfunction and tension.3.The level of BDNF and NGF in patients with epilepsy complicated with depression/anxiety disorder was significantly lower than that in control group,while the level of serum IL-6 IL-1β was significantly higher than that in patients without epilepsy complicated with depression/anxiety disorder.4.Serum levels of BDNF were negatively correlated with HAMD Hama score,while levels of inflammatory factors such as IL-6,IL-1βwere positively correlated with HAMD and HAMA score.5.Serum Cytokines such as BDNF,IL-6,IL-1β participate in the development of epilepsy with depression/anxiety disorders. |
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