压力与抽搐:彼此间的诱发关系如何?


  【24drs.com】新研究认为压力造成抽搐发生,而压力原本即被许多癫痫病患形容为诱发因子。
  
  新研究的结果检视了压力状态如何影响抽搐频率、增加脑活性,发表于美国癫痫协会(AES)第66届年会。
  
  根据辛辛那提大学癫痫中心主任Michael Privitera医师等人进行的研究结果,神经科医师应帮那些认为压力造成自己癫痫的病患确认是否有潜在的忧郁或焦虑异常,因为很可能确实如此。
  
  这篇研究包括了这个癫痫中心的203名门诊病患,这些病患认为压力诱发他们的抽搐;研究者要求这些「压力阳性」病患确认压力引起抽搐的时间(数日到数月),以及引起抽搐的急性压力场合(几分钟到几小时)。
  
  询问这些病患是否有尝试舒缓压力的技巧、是否认为这些方法有助于减少抽搐;此外,也询问他们预期发生抽搐的能力。
  
  研究者也收集了有关抽搐类型、忧郁及焦虑病史和治疗的相关信息。
  
  研究期间,研究者搜集了认为压力对自己的抽搐无影响的28名患者作为对照组,视为「压力阴性」病患。Privitera医师表示,要找到这样认为的病患有点困难。
  
  研究显示,85%的压力阳性病患相信慢性压力是抽搐诱发因子,68%认为急性压力是诱发因子;这些病患中,57%有使用某种的松弛或减压治疗,其中,88%认为这些疗法改善了抽搐。
  
  研究者表示,真正有趣的是,这些人曾经尝试过各种减压方法,瑜珈排名第一,这相当令人惊讶,因为这里是辛辛那提,而非这类方法更普及的加州,此外,病患也尝试了放松和其它减压技巧;另有25%的压力阴性病患尝试过放松或减压,其中71%认为他们的抽搐随之改善。
  
  根据该研究,忧郁病史、焦虑(广泛性焦虑症7项量表[GAD-7])分数、忧郁(神经异常忧郁量表-测量癫痫分数较高都是压力阳性的相关因素(胜算比[OR] > 1);在多变项逻辑回归分析中,只有GAD-7分数和抽搐预测与压力阳性有关。
  
  研究发现,压力阳性病患更可能相信他们至少会偶尔发作抽搐(压力阳性和压力阴性病患分别是51.8%与14.3%;OR,8.6;P = .0005)。
  
  研究者现在正进行一项有关减压介入方式(每天两次呼吸运动和其它技巧的行为集中注意训练)的随机临床试验,对象是认为抽搐是因压力诱发的药物阻抗性癫痫患者。
  
  阿拉巴马大学讲师、进行过压力之于抽搐角色研究的Jane Allendorfer博士受邀评论时表示,研究结果和之前癫痫病患认为压力是抽搐诱发因子的结果一致,其中有些病患认为自己可以预测抽搐发作;其它研究显示,多达50%的癫痫病患认为压力是抽搐的诱发因子。
  
  她表示,病患尝试减压技巧是因为认为可减少抽搐的论点是很有趣,但不令人意外,因为作者们在癫痫药物阻抗病患的减压方法对照试验中也证明,希望他们的资料可以分成控制抽搐的患者与其它病患来分析。
  
  Allendorfer博士曾经在辛辛那提大学进行过一篇研究且发表在AES会议,认为那些相信压力对抽搐有所影响者,脑部对压力的反应也有显著差异。
  
  在一系列实验中,认为压力是自己抽搐之重要因素患者,当面对压力时,脑部有更多活性现象;压力情境为,播放声音要求他们在有限时间内解决一个数学问题,催促要他们尽速完成,否则对研究就无帮助。
  
  脑部活性增加范围包括两侧的颞上回、后扣带回和颅顶区,以及左侧的脑岛。
  
  相反的,在不认为压力是抽搐主因的对照组病患,脑部活性并未增加,对照组这种缺乏脑部活性的发现则是令人惊讶。
  
  Allendorfer博士表示,认为抽搐是压力引起的病患,其脑部活性增加,有可能是因为试图和其它参与者相同表现的代偿机制。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6966&x_classno=0&x_chkdelpoint=Y
  

Stress and Seizures: What Drives the Relationship?

By Pauline Anderson
Medscape Medical News

San Diego, California — Emerging research is illuminating the contribution of stress, which many patients with epilepsy describe as a trigger, to the occurrence of seizures.

Results of new studies examining how stressful situations might affect seizure frequency, and increase brain activation, were presented here at the American Epilepsy Society (AES) 66th Annual Meeting.

Neurologists should determine whether there is an underlying depression or anxiety disorder in patients convinced that stress is driving their epilepsy because this could very well be the case, according to results of a study carried out by Michael Privitera, MD, professor, and director, Cincinnati Epilepsy Center, University of Cincinnati, and his colleagues.

Stress Positive

The study included 203 outpatients at the epilepsy center who believe that stress plays a role in triggering their seizures. Researchers asked these "stress-positive" patients to identify times when stress lasting days to months made their seizures more likely and also instances where an acute stress lasting minutes to hours triggered a seizure.

Patients were asked whether they had tried stress reduction techniques and whether they thought these efforts reduced their seizures. They were also queried about their ability to predict seizures.

The investigators also gathered relevant information on seizure type and history of and treatment for depression and anxiety.

Midway through the study, researchers gathered data on a control population of 28 patients who thought stress played no role in their seizures, or "stress-negative" patients. Dr. Privitera commented that finding such patients was somewhat difficult.

The study showed that 85% of stress-positive patients believed that chronic stress was a seizure trigger, and 68% endorsed acute stress as a trigger. In these patients, 57% used some type of relaxation or stress reduction treatment, and of those, 88% thought it improved seizures.

"What was really interesting was that these people have tried all kinds of stress reduction methods, and yoga was number one, which is surprising since this is Cincinnati," and not California, where such approaches might be more popular, he said. Patients also tried relaxation and other stress reduction techniques.

Interestingly, 25% of stress-negative patients tried relaxation or stress reduction and 71% of them thought their seizures subsequently improved.

A history of depression, higher anxiety scores (Generalized Anxiety Disorder 7-item [GAD-7]) and depression scores (Neurological Disorders Depression Inventory for Epilepsy) are factors associated with being stress positive (odds ratio [OR] > 1), according to the study. In a multivariable logistic regression analysis, only GAD-7 score and seizure prediction were associated with being stress positive.

Stress-positive patients were more likely to believe they could at least occasionally predict seizures (51.8% vs 14.3% for stress-negative patients; OR, 8.6; P = .0005), the study found.

The researchers are now carrying out a randomized clinical trial of a stress reduction intervention (behavioral focused attention consisting of twice-daily practices of breathing exercises and other techniques) in drug-resistant patients with epilepsy who believe their seizures are triggered by stress.

Asked to comment, Jane Allendorfer, PhD, instructor, University of Alabama at Birmingham, who has done research on the role of stress in seizures, said the results of the study are consistent with previous findings of patients with epilepsy who reported stress as a seizure trigger, some of whom believe they can predict seizures. Other research shows that up to 50% of people with epilepsy believe stress is a trigger for seizures.

"It's interesting, but not surprising, that patients who tried stress reduction techniques believed it reduced seizures," she said. "Given the authors' indication of a controlled trial of stress reduction methods in patients with medication resistant epilepsy, I would like to see their data broken up into patients who have their seizures controlled versus other patients."

Significant Brain Response

A study Dr. Allendorfer carried out while she was at the University of Cincinnati and that she presented at the AES meeting here suggests that people who believe stress plays a role in their seizures actually do have significant differences in brain response to stress.

In a series of experiments, patients who perceived stress as an important contributing factor to their seizures had more brain activation when under stress. The stress was created by having to complete a mathematical problem in a finite time with an overhead voice providing negative feedback and telling them that they had to finish soon or they couldn't contribute to the study.

The increases in brain activation were seen bilaterally in the superior temporal gyrus, posterior cingulate, and parietal areas, and unilaterally in the left insula.

Conversely, brain activation did not increase in a control group of patients who didn't think stress was a major factor in seizures. This lack of brain activation in controls was surprising, said Dr. Allendorfer.

The increased brain activation in patients who believe seizures are triggered by stress may be part of a compensatory mechanism — trying to perform as well as other participants, said Dr. Allendorfer.

American Epilepsy Society (AES) 66th Annual Meeting. Abstracts 1.184, 1.243. Presented December 1, 2012.

    
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