脳神経外科通院中のてんかん患者の気分障害とラモトリギンによる改善効果

Mood States in Outpatients with Lesional Epilepsy at the Neurosurgical Clinic and Improvement in Mood States after Lamotrigine Addiction

Ⅰ．はじめに

　脳神経外科が対象とするてんかん症例では，頭部外傷や脳腫瘍などに伴う症候性局在関連てんかんが多数を占める．近年，てんかん患者の治療においては，てんかん発作のコントロールを含めたquality of life（QOL）の向上が求められている．一方，脳神経外科に通院中の症候性部分てんかん患者においては，てんかん発作のコントロールが主眼となるため，併発する気分障害に関する報告は少ない．今回，われわれは，2つの質問紙票を用いて，脳神経外科に通院するてんかん患者の気分を評価した．また，新規抗てんかん薬ラモトリギン（LTG）は，てんかん患者の気分障害を改善することが知られている^4,6,19)．このことからLTG服薬開始前後のてんかん患者の気分の変化を検討した．

　People with epilepsy have a high incidence of mood disorders that may affect their quality of life. Lamotrigine（LTG）is one of the antiepileptic drugs that are commercially available in Japan these days and its mood-stabilizing qualities were well known. First, 66 outpatients with epilepsy were evaluated for changes in mood states by the Profile of Mood States（POMS）and the Japanese-edition Beck Depression Inventory-Second Edition（BDI-II）on self report. The POMS questionnaire includes 30 items that address six components of mood. At baseline, one third of the outpatients with epilepsy had mood problems compared by POMS health reference. The mean BDI-II baseline score was 14.9±10.1, and one third of these epilepsy patients exhibited moderate or severe depression. Second, in the twelve patients with epilepsy, LTG was added to other antiepileptic drugs, and the POMS and BDI-II were administered at baseline and after addiction to LTG. 4 out of 8（50%）patients with simple partial seizure and 5 out of 8（62.5%）patients after the adjunctive therapy experienced at least a 50% reduction in the number of seizures compared with the self-reported baseline before the adjunctive therapy. The component scores of Depression-Dejection, Anger-Hostility and Confusion-Bewilderment in POMS were statistically improved in these patients completing adjunctive LTG（pared t-test, p＜0.05). In these patients, the mean BDI-II baseline score was 25.8±13.1. Following administration of LTG, there was a significant decrease in the mean BDI-II scores（15.0±6.6）between baseline and the end of adjunctive LTG.

　This study suggests that, in addition to seizure control, LTG may have a mood-stabilizing effect and improve the quality of life in patients with epilepsy.