癫痫共患双相情感障碍诊治的研究进展
Research Progress in the Diagnosis and Treatment of Epilepsy Comorbidity with Bipolar Disorder
摘要: 癫痫共患病显著增加了癫痫治疗难度的同时对预后产生负面影响，在众多癫痫共患病中双相情感障碍因临床表现复杂、自杀风险高、预后不良，成为癫痫共患精神疾病中需重点关注的类型。癫痫与双相情感障碍存在双向作用，二者均为发作性疾病且可进展为慢性病程。本文将从癫痫共患双相情感障碍的联系、流行病学、病因学、发病机制、生物学标记物、评估诊断方法和治疗措施等几个方面进行综述。但二者发病机制与治疗相关研究仍存在局限，临床需重视癫痫共患双相情感障碍的系统化管理，以改善患者预后，提升生存质量。
Abstract: Comorbidities in epilepsy increase treatment difficulty and worsen prognosis, among which bipolar disorder is a key psychiatric comorbidity requiring focused attention due to its complex manifestations, high suicide risk and poor prognosis. Epilepsy and bipolar disorder interact bidirectionally, both being paroxysmal and potentially chronic. This article reviews their association, epidemiology, etiology, pathogenesis, biological markers, assessment, diagnosis and treatment. However, research on their pathogenesis and treatment is limited; clinical systematic management is essential to improve patient prognosis and quality of life.
文章引用：梁钰. 癫痫共患双相情感障碍诊治的研究进展[J]. 临床医学进展, 2026, 16(2): 2153-2159. https://doi.org/10.12677/acm.2026.162614

参考文献

[1] 李世绰, 洪震. 临床诊疗指南, 癫痫病分册[M]. 北京: 人民卫生出版社, 2015.
[2] Keezer, M.R., Sisodiya, S.M. and Sander, J.W. (2016) Comorbidities of Epilepsy: Current Concepts and Future Perspectives. The Lancet Neurology, 15, 106-115. [Google Scholar] [CrossRef] [PubMed]
[3] 方贻儒, 汪作为, 陈俊. 中国双相障碍的研究现状与展望[J]. 中华精神科杂志, 2015, 48(3): 141-146.
[4] Wiglusz, M.S., Landowski, J., Cubała, W.J. and Agius, M. (2015) Overlapping Phenomena of Bipolar Disorder and Epilepsy—A Common Pharmacological Pathway. Psychiatria Danubina, 27, S177-S181.
[5] Knott, S., Forty, L., Craddock, N. and Thomas, R.H. (2015) Epilepsy and Bipolar Disorder. Epilepsy & Behavior, 52, 267-274. [Google Scholar] [CrossRef] [PubMed]
[6] Falco-Walter, J. (2020) Epilepsy—Definition, Classification, Pathophysiology, and Epidemiology. Seminars in Neurology, 40, 617-623. [Google Scholar] [CrossRef] [PubMed]
[7] Vieta, E., Berk, M., Schulze, T.G., Carvalho, A.F., Suppes, T., Calabrese, J.R., et al. (2018) Bipolar Disorders. Nature Reviews Disease Primers, 4, Article No. 18008. [Google Scholar] [CrossRef] [PubMed]
[8] Wotton, C.J. and Goldacre, M.J. (2014) Record-Linkage Studies of the Coexistence of Epilepsy and Bipolar Disorder. Social Psychiatry and Psychiatric Epidemiology, 49, 1483-1488. [Google Scholar] [CrossRef] [PubMed]
[9] Alsaadi, T., El Hammasi, K., Shahrour, T.M., Shakra, M., Turkawi, L., Nasreddine, W., et al. (2015) Depression and Anxiety among Patients with Epilepsy and Multiple Sclerosis: UAE Comparative Study. Behavioural Neurology, 2015, Article ID: 196373. [Google Scholar] [CrossRef] [PubMed]
[10] Feinstein, J.S., Gould, D. and Khalsa, S.S. (2022) Amygdala-Driven Apnea and the Chemoreceptive Origin of Anxiety. Biological Psychology, 170, Article 108305. [Google Scholar] [CrossRef] [PubMed]
[11] Post, R.M., Uhde, T.W., Putnam, F.W., Ballenger, J.C. and Berrettini, W.H. (1982) Kindling and Carbamazepine in Affective Illness. The Journal of Nervous and Mental Disease, 170, 717-731. [Google Scholar] [CrossRef] [PubMed]
[12] Lopez, A.Y., Wang, X., Xu, M., Maheshwari, A., Curry, D., Lam, S., et al. (2017) Ankyrin-G Isoform Imbalance and Interneuronopathy Link Epilepsy and Bipolar Disorder. Molecular Psychiatry, 22, 1464-1472. [Google Scholar] [CrossRef] [PubMed]
[13] Villacres, J.E., Riveira, N., Kim, S., Colgin, L.L., Noebels, J.L. and Lopez, A.Y. (2023) Abnormal Patterns of Sleep and Waking Behaviors Are Accompanied by Neocortical Oscillation Disturbances in an Ank3 Mouse Model of Epilepsy-Bipolar Disorder Comorbidity. Translational Psychiatry, 13, Article No. 403. [Google Scholar] [CrossRef] [PubMed]
[14] Johnson, E.L. (2019) Seizures and Epilepsy. Medical Clinics of North America, 103, 309-324. [Google Scholar] [CrossRef] [PubMed]
[15] Phillips, M.L. and Kupfer, D.J. (2013) Bipolar Disorder Diagnosis: Challenges and Future Directions. The Lancet, 381, 1663-1671. [Google Scholar] [CrossRef] [PubMed]
[16] Numakawa, T., Odaka, H. and Adachi, N. (2018) Actions of Brain-Derived Neurotrophin Factor in the Neurogenesis and Neuronal Function, and Its Involvement in the Pathophysiology of Brain Diseases. International Journal of Molecular Sciences, 19, Article 3650. [Google Scholar] [CrossRef] [PubMed]
[17] Li, Z., Zhang, C., Fan, J., Yuan, C., Huang, J., Chen, J., et al. (2014) Brain-Derived Neurotrophic Factor Levels and Bipolar Disorder in Patients in Their First Depressive Episode: 3-Year Prospective Longitudinal Study. British Journal of Psychiatry, 205, 29-35. [Google Scholar] [CrossRef] [PubMed]
[18] Thomaidis, G.V., Papadimitriou, K., Michos, S., Chartampilas, E. and Tsamardinos, I. (2023) A Characteristic Cerebellar Biosignature for Bipolar Disorder, Identified with Fully Automatic Machine Learning. IBRO Neuroscience Reports, 15, 77-89. [Google Scholar] [CrossRef] [PubMed]
[19] Niu, X., Zhu, H., Liu, Q., Yan, J. and Li, M. (2021) MiR-194-5p Serves as a Potential Biomarker and Regulates the Proliferation and Apoptosis of Hippocampus Neuron in Children with Temporal Lobe Epilepsy. Journal of the Chinese Medical Association, 84, 510-516. [Google Scholar] [CrossRef] [PubMed]
[20] Yoshino, Y. and Dwivedi, Y. (2020) Non-Coding RNAs in Psychiatric Disorders and Suicidal Behavior. Frontiers in Psychiatry, 11, Article ID: 543893. [Google Scholar] [CrossRef] [PubMed]
[21] Drange, O.K., Sæther, S.G., Finseth, P.I., Morken, G., Vaaler, A.E., Arntsen, V., et al. (2020) Differences in Course of Illness between Patients with Bipolar II Disorder with and without Epileptiform Discharges or Other Sharp Activity on Electroencephalograms: A Cross-Sectional Study. BMC Psychiatry, 20, Article No. 582. [Google Scholar] [CrossRef] [PubMed]
[22] Pawar, A.S. and Kattah, A.G. (2018) Lithium-Induced Nephropathy. New England Journal of Medicine, 378, 1042-1042. [Google Scholar] [CrossRef] [PubMed]
[23] Peselow, E.D., Clevenger, S. and IsHak, W.W. (2016) Prophylactic Efficacy of Lithium, Valproic Acid, and Carbamazepine in the Maintenance Phase of Bipolar Disorder. International Clinical Psychopharmacology, 31, 218-223. [Google Scholar] [CrossRef] [PubMed]
[24] Hashimoto, Y., Kotake, K., Watanabe, N., Fujiwara, T. and Sakamoto, S. (2021) Lamotrigine in the Maintenance Treatment of Bipolar Disorder. Cochrane Database of Systematic Reviews, No. 9, CD013575. [Google Scholar] [CrossRef] [PubMed]
[25] Miranda, A.S.D., Miranda, A.S.D. and Teixeira, A.L. (2018) Lamotrigine as a Mood Stabilizer: Insights from the Pre-Clinical Evidence. Expert Opinion on Drug Discovery, 14, 179-190. [Google Scholar] [CrossRef] [PubMed]
[26] Chouchana, M., Smati, J., Bloch, V., Fontan, J., Etain, B. and Delage, C. (2023) Lamotrigine in Mood Disorders: Flash Survey on Prescribing Habits and Blood Tests Practices. L’Encéphale, 49, 640-644. [Google Scholar] [CrossRef] [PubMed]
[27] 周绍宇, 靳西龙, 冯振晓, 赵丽华. 碳酸锂缓释片治疗双相情感障碍的躁狂发作的疗效探讨[J]. 中国药物与临床, 2019, 19(19): 3282-3285.
[28] Miras-Portugal, M.T., Queipo, M.J., Gil-Redondo, J.C., Ortega, F., Gómez-Villafuertes, R., Gualix, J., et al. (2019) P2 Receptor Interaction and Signalling Cascades in Neuroprotection. Brain Research Bulletin, 151, 74-83. [Google Scholar] [CrossRef] [PubMed]
[29] Beamer, E., Kuchukulla, M., Boison, D. and Engel, T. (2021) ATP and Adenosine—Two Players in the Control of Seizures and Epilepsy Development. Progress in Neurobiology, 204, Article 102105. [Google Scholar] [CrossRef] [PubMed]
[30] Chen, J., Zhang, L., Liu, K., Chen, H., Zhou, S., Wang, N., et al. (2019) Patients with Drug-Naive Bipolar Disorder in Remission after 8 Weeks of Treatment Had Decreased Serum Uric Acid Concentrations. Frontiers in Psychiatry, 10, Article ID: 767. [Google Scholar] [CrossRef] [PubMed]
[31] Cano-López, I. and González-Bono, E. (2019) Cortisol Levels and Seizures in Adults with Epilepsy: A Systematic Review. Neuroscience & Biobehavioral Reviews, 103, 216-229. [Google Scholar] [CrossRef] [PubMed]
[32] Boison, D. and Rho, J.M. (2020) Epigenetics and Epilepsy Prevention: The Therapeutic Potential of Adenosine and Metabolic Therapies. Neuropharmacology, 167, Article 107741. [Google Scholar] [CrossRef] [PubMed]
[33] Daniels, S.D. and Boison, D. (2023) Bipolar Mania and Epilepsy Pathophysiology and Treatment May Converge in Purine Metabolism: A New Perspective on Available Evidence. Neuropharmacology, 241, Article 109756. [Google Scholar] [CrossRef] [PubMed]
[34] Goes, F.S. (2023) Diagnosis and Management of Bipolar Disorders. BMJ, 381, e073591. [Google Scholar] [CrossRef] [PubMed]
[35] DeCou, C.R., Comtois, K.A. and Landes, S.J. (2019) Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. Behavior Therapy, 50, 60-72. [Google Scholar] [CrossRef] [PubMed]
[36] 胡晨, 史晓宁, 路亚洲. 药物联合辨证行为疗法综合治疗双相情感障碍共病癫痫1例[J]. 中国临床案例成果数据库, 2024, 6(1): E0848.
[37] Sethi, S., Wakeham, D., Ketter, T., Hooshmand, F., Bjornstad, J., Richards, B., et al. (2024) Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial. Psychiatry Research, 335, Article 115866. [Google Scholar] [CrossRef] [PubMed]
[38] Norwitz, N.G., Sethi, S. and Palmer, C.M. (2020) Ketogenic Diet as a Metabolic Treatment for Mental Illness. Current Opinion in Endocrinology, Diabetes & Obesity, 27, 269-274. [Google Scholar] [CrossRef] [PubMed]

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