PDF(Pubmed)
Abstract：
Background/Objectives: To determine the impact of psychiatric disorders on epilepsy treatment outcomes and healthcare utilization in children with epilepsy (CWE) based on the presence or timing of the onset of psychiatric disorders. Methods: This retrospective controlled study enrolled children (age < 18 years) with newly diagnosed epilepsy into four groups stratified by the presence and timing of the onset of psychiatric disorders (None: no psychiatric disorders; Before: psychiatric disorders only preceding the epilepsy diagnosis; After: new psychiatric disorders diagnosed only after the epilepsy diagnosis; Mixed: different psychiatric disorders diagnosed both before and after epilepsy diagnosis) and compared the intergroup differences in epilepsy treatment outcomes and healthcare utilization. Results: Among the CWE (n = 37,678), 13,285 (35.26%) had comorbid psychiatric disorders. The After (n = 7892), Mixed (n = 3105), and Before (n = 2288) groups had significantly longer treatment periods than those in the None group (p < 0.001). Compared with the None group, the remaining groups had significantly higher frequencies of outpatient visits, emergency room visits, and admissions and higher rates of status epilepticus and drug-resistant epilepsy (p < 0.001, respectively), with higher odds ratios [95% confidence interval] for status epilepticus (2.92 [2.68-3.18]) and drug-resistant epilepsy (3.01 [2.85-3.17]) in the After group. Conclusions: Psychiatric comorbidities, diagnosed before and after epilepsy diagnosis, negatively affected the treatment outcomes. CWE without prior psychiatric disorders that were newly diagnosed during epilepsy treatment had the worst outcomes and the highest healthcare utilization rates.
摘要：
背景/目标：根据精神病发作的存在或时机，确定精神病对癫痫患儿（CWE）癫痫治疗结果和医疗保健利用的影响。方法：这项回顾性对照研究将新诊断为癫痫的儿童（年龄<18岁）分为四组，根据精神疾病的出现和发作时间进行分层（无：无精神疾病；之前：仅在癫痫诊断之前有精神疾病；之后：仅在癫痫诊断后才诊断出新的精神疾病；混合：在癫痫诊断之前和之后诊断出不同的精神疾病），并比较了癫痫治疗结果和医疗保健利用的组间差异。结果：在CWE中（n=37,678），13,285(35.26%)患有精神疾病。之后（n=7892），混合（n=3105），和之前（n=2288）组的治疗时间明显长于None组（p<0.001）。与None组相比，其余组的门诊就诊频率明显较高，急诊室探视,入院率和癫痫持续状态和耐药癫痫的发生率较高（分别为p<0.001），后组癫痫持续状态(2.92[2.68-3.18])和耐药癫痫(3.01[2.85-3.17])的比值比[95%置信区间]较高。结论：精神病合并症，在癫痫诊断之前和之后诊断，对治疗结果产生负面影响。在癫痫治疗期间新诊断的没有先前精神疾病的CWE具有最差的结果和最高的医疗保健利用率。
