187例成人睡眠相关性癫痫患者的临床特征及视频脑电图分析
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摘要
目的总结分析成人睡眠相关性癫痫患者临床特征及视频脑电图特点,为临床诊断、鉴别诊断及治疗提供依据。方法收集2017年1月–2017年12月在中南大学湘雅医院神经内科诊治的187例成人睡眠相关性癫痫患者的临床资料和常规脑电图(EEG)、长程视频脑电图(VEEG),采用χ~2检验进行回顾性分析。结果临床表现:187例成人睡眠相关性癫痫患者病程集中在1～10年内101例(54.01%);发作频率主要为1年发作几次至几十次99例(52.94%);两种或两种以上发作类型119例(63.64%);其中发作表现为局灶性起源121例次(39.29%),局灶进展为双侧强直阵挛152例次(49.35%);两种及以上药物治疗110例(58.82%)。EEG结果:(1)常规EEG癫痫样放电检出率为22.78%,VEEG癫痫样放电检出率为80.43%,两种检查方法比较差异有统计学意义(P <0.01);(2)发作间期常规EEG监测到18例癫痫样放电,VEEG监测到111例癫痫样放电;(3)监测到56次发作性事件,均发生在VEEG监测过程中;其中50次发生在睡眠期(89.29%),6次发生在清醒期(10.71%);结合临床45次(80.36%)确诊为癫痫发作,9次(16.07%)确诊为非癫痫发作,不能确定其发作性质2例(3.57%);(4)VEEG监测中睡眠期癫痫样放电检出率高于清醒期,差异有统计学意义(P<0.01)。睡眠分期中NREMⅠ–Ⅱ期癫痫样放电检出率所占比例最高。结论成人睡眠相关性癫痫具有一定的临床特征和EEG表现,VEEG相较常规EEG更能提高癫痫样放电的检出率,且对睡眠期发作事件的定性提供诊断依据,并能反映癫痫样放电与睡眠之间的关系,对成人睡眠相关性癫痫的临床诊治提供依据。
Objective To summarize and analyze the clinical and video-EEG(VEEG) characteristics of adult sleep-related epilepsy, so as to provide evidence for clinical diagnosis, differential diagnosis and treatment. Methods The clinical data, routine EEG and long-term VEEG of 187 adult patients with sleep-related epilepsy treated in Department of Neurology, Xiangya Hospital, Central South University from January 2017 to December 2017 were retrospectively analyzed by χ~2 test. Results Clinical manifestations: The duration of sleep-related epilepsy in 187 adults was concentrated in 1～10 years(101 cases, 54.01%); the frequency of seizures was mainly from several to dozens of times a year(99 cases,52.94%); 119 cases(63.64%) had two or more types of seizures. Among the patients, 121 cases(39.29%) had focal origin,152 cases(49.35%) had bilateral tonic clonus and 110 cases(58.82%) were treated with two or more drugs. EEG results:(1)The detection rate of epileptiform discharges in routine EEG was 22.78%, and that in long-term video EEG was 80.43%.There was significant difference between the two methods(P< 0.01);(2) Eighteen epileptiform discharges were monitored by routine EEG during interparoxysmal period and 111 epileptiform discharges were monitored by video EEG; and(3)Fifty-six epileptic events were monitored and all occurred in the process of long-term VEEG monitoring, 50 of them occurred in sleep(89.29%) and 6 in awake(10.71%); 45 cases(80.36%) were diagnosed as epileptic seizures, 9 cases(16.07%) were diagnosed as non-epileptic seizures, and 2 cases(3.57%) could not be determined.(4) The detection rate of epileptic discharges during sleep was higher than that during awake period in long-term VEEG monitoring(P< 0.01). The detection rate of epileptiform discharges in NREM stage I–II was the highest in sleep stage. Conclusion Sleep-related epilepsy in adults has certain clinical features and EEG manifestations. Compared with conventional EEG, long-term video-EEG can improve the detection rate of epileptiform discharges, provide diagnostic basis for the qualitative analysis of sleep-related seizures, and reflect the relationship between epileptiform discharges and sleep, and provide basis for the clinical diagnosis and treatment of sleep-related epilepsy in adults.
Objective To summarize and analyze the clinical and video-EEG(VEEG) characteristics of adult sleep-related epilepsy, so as to provide evidence for clinical diagnosis, differential diagnosis and treatment. Methods The clinical data, routine EEG and long-term VEEG of 187 adult patients with sleep-related epilepsy treated in Department of Neurology, Xiangya Hospital, Central South University from January 2017 to December 2017 were retrospectively analyzed by χ~2 test. Results Clinical manifestations: The duration of sleep-related epilepsy in 187 adults was concentrated in 1～10 years(101 cases, 54.01%); the frequency of seizures was mainly from several to dozens of times a year(99 cases,52.94%); 119 cases(63.64%) had two or more types of seizures. Among the patients, 121 cases(39.29%) had focal origin,152 cases(49.35%) had bilateral tonic clonus and 110 cases(58.82%) were treated with two or more drugs. EEG results:(1)The detection rate of epileptiform discharges in routine EEG was 22.78%, and that in long-term video EEG was 80.43%.There was significant difference between the two methods(P< 0.01);(2) Eighteen epileptiform discharges were monitored by routine EEG during interparoxysmal period and 111 epileptiform discharges were monitored by video EEG; and(3)Fifty-six epileptic events were monitored and all occurred in the process of long-term VEEG monitoring, 50 of them occurred in sleep(89.29%) and 6 in awake(10.71%); 45 cases(80.36%) were diagnosed as epileptic seizures, 9 cases(16.07%) were diagnosed as non-epileptic seizures, and 2 cases(3.57%) could not be determined.(4) The detection rate of epileptic discharges during sleep was higher than that during awake period in long-term VEEG monitoring(P< 0.01). The detection rate of epileptiform discharges in NREM stage I–II was the highest in sleep stage. Conclusion Sleep-related epilepsy in adults has certain clinical features and EEG manifestations. Compared with conventional EEG, long-term video-EEG can improve the detection rate of epileptiform discharges, provide diagnostic basis for the qualitative analysis of sleep-related seizures, and reflect the relationship between epileptiform discharges and sleep, and provide basis for the clinical diagnosis and treatment of sleep-related epilepsy in adults.
引文
1Kirsten MF, Khara MS, Samuel W, et al. Prevalence and incidenceof epilepsy:A systematic review and meta-analysis of international studies. Neurology, 2017, 88(3):296-303.
2蔡梦婷,丁美萍.癫痫患者对照料者和家庭及社会的影响研究.癫痫杂志, 2018, 4(4):330-333.
3Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies:position paper of the ILAE commission for classification and terminology. Epilepsia, 2017, 58(4):512-521.
4孙忠华.睡眠相关性癫病:2008年中国睡眠研究会第五届学术年会论文集.昆明:中国睡眠研究会, 2008:245-250.
5Eriksson SH. Epilepsy and sleep. Curr Opin Neurol, 2011, 24(2):171-176.
6Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic:a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115:119-125.
7Rocamora R, Sánchez-Alvarez JC, Salas-Puig J. The relationship between sleep and epilepsy. Neurologist, 2008, 14(6 Suppl 1):35-43.
8Bazil CW, Castro LH, Walczak TS. Reduction of rapid eye movement sleep by diurnal and nocturnal seizures in temporal lobe epilepsy. Arch Neurol, 2000, 57(3):363-368.
9UnterbergerI, Gabelia D, Prieschl M, et al. Sleep disorders and circadian rhythm in epilepsy revisited:a prospective controlled study. Sleep Med, 2015, 16(2):237-242.
10 黄莎,肖波,龙莉莉,等.长程视频脑电图在癫痫诊断与鉴别诊断中的作用.中国现代神经疾病杂志, 2014, 11(14):987-989.
11方赟,葛剑青,王凌玲,等.长程视频脑电图监测对睡眠相关性癫痫的诊断价值.南京医科大学学报(自然科学版), 2016, 11(11):1376-1378.
12Li P, Ghadersohi S, Jafari B, et al. Characteristics of refractory vs medically controlled epilepsy patients with obstructive sleep apnea and their response to CPAP treatment. Seizure, 2012, 21(9):717-721.
13Kataria L, Vanghn BV. Sleep and epilepsy. Sleep Med Clin, 2016,11(1):25-38.
14Lucey BP, Noetzel MJ, Duntley SP. Paroxysmal arousals and myoclonic movements associated with interictal epileptiform discharges in NREM and REM sleep. Clin Neurol Neurosurg, 2011,113(5):419-422.
15Busek P, Buskova J, Nevsimalova S. Interictal epileptiform discharges and phasic phenomena of REM sleep. Epileptic Disord,2010, 12(3):217-221.
16James D, Geyer EE, Fetterman Z, et al. Epilepsy and restless legs syndrome. Epilepsy Behav, 2017, 68:41-44.
17Jain SV, Horn PS, Simakajornboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1):77-82.
18Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic:a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115:119-125.
19Jain SV, Horn PS, SimakaJomboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1):77.
20Chihorek AM, Abou-Khalil B, Malow BA. Obstructive sleep apneais associated with seizure occurrence in older adults with epilepsy. Neurology, 2007, 69(19):1823-1827.
21 Zhou JY, Tang XD, Huang LL, et a1. The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patientswith partial epilepsy. J Clin Neurosci, 2012, 19(7):956-960.
2蔡梦婷,丁美萍.癫痫患者对照料者和家庭及社会的影响研究.癫痫杂志, 2018, 4(4):330-333.
3Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies:position paper of the ILAE commission for classification and terminology. Epilepsia, 2017, 58(4):512-521.
4孙忠华.睡眠相关性癫病:2008年中国睡眠研究会第五届学术年会论文集.昆明:中国睡眠研究会, 2008:245-250.
5Eriksson SH. Epilepsy and sleep. Curr Opin Neurol, 2011, 24(2):171-176.
6Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic:a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115:119-125.
7Rocamora R, Sánchez-Alvarez JC, Salas-Puig J. The relationship between sleep and epilepsy. Neurologist, 2008, 14(6 Suppl 1):35-43.
8Bazil CW, Castro LH, Walczak TS. Reduction of rapid eye movement sleep by diurnal and nocturnal seizures in temporal lobe epilepsy. Arch Neurol, 2000, 57(3):363-368.
9UnterbergerI, Gabelia D, Prieschl M, et al. Sleep disorders and circadian rhythm in epilepsy revisited:a prospective controlled study. Sleep Med, 2015, 16(2):237-242.
10 黄莎,肖波,龙莉莉,等.长程视频脑电图在癫痫诊断与鉴别诊断中的作用.中国现代神经疾病杂志, 2014, 11(14):987-989.
11方赟,葛剑青,王凌玲,等.长程视频脑电图监测对睡眠相关性癫痫的诊断价值.南京医科大学学报(自然科学版), 2016, 11(11):1376-1378.
12Li P, Ghadersohi S, Jafari B, et al. Characteristics of refractory vs medically controlled epilepsy patients with obstructive sleep apnea and their response to CPAP treatment. Seizure, 2012, 21(9):717-721.
13Kataria L, Vanghn BV. Sleep and epilepsy. Sleep Med Clin, 2016,11(1):25-38.
14Lucey BP, Noetzel MJ, Duntley SP. Paroxysmal arousals and myoclonic movements associated with interictal epileptiform discharges in NREM and REM sleep. Clin Neurol Neurosurg, 2011,113(5):419-422.
15Busek P, Buskova J, Nevsimalova S. Interictal epileptiform discharges and phasic phenomena of REM sleep. Epileptic Disord,2010, 12(3):217-221.
16James D, Geyer EE, Fetterman Z, et al. Epilepsy and restless legs syndrome. Epilepsy Behav, 2017, 68:41-44.
17Jain SV, Horn PS, Simakajornboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1):77-82.
18Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic:a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115:119-125.
19Jain SV, Horn PS, SimakaJomboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1):77.
20Chihorek AM, Abou-Khalil B, Malow BA. Obstructive sleep apneais associated with seizure occurrence in older adults with epilepsy. Neurology, 2007, 69(19):1823-1827.
21 Zhou JY, Tang XD, Huang LL, et a1. The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patientswith partial epilepsy. J Clin Neurosci, 2012, 19(7):956-960.
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