睡眠剥夺对癫(癎)患儿(癎)波发放及其对正常睡眠波的影响

目的探讨癫患儿在睡眠剥夺(SD)诱发试验中波检出率及波发放对睡眠中顶尖波、睡眠纺锤波的影响。方法对160例不同年龄、临床拟诊为癫的患儿SD后进行清醒及睡眠脑电图检查。结果SD后脑电图癫波检出率睡眠时(59.3%)明显高于清醒时(16.3%)(P<0.01);≥6岁组(82.9%)及2～5岁组(72.0%)癫波检出率高于<2岁组(36.2%)(均P<0.01);≥6个月的137例患儿中,36例纺锤波或顶尖波缺如,其中72.0%出现癫波频繁发放,101例纺锤波、顶尖波正常,仅9.9%出现波频发(P<0.01)。结论SD可明显提高癫患儿癫波的检出率;<2岁的癫患儿癫波检出率低;波频繁发放对正常顶尖波、纺锤波产生抑制作用。     

女性癫诊断与治疗新理念:分阶段 重管理

癫是常见的神经系统疾病,其中女性患者较男性患者具有一定的特殊性,癫发作或服用抗癫药物均对女性生理发育各阶段产生影响,故在选择抗癫药物时应考虑多方面因素,"分阶段"制定治疗策略。女性患者易罹患情感障碍、心理障碍、精神障碍和睡眠障碍等共患病,癫长期累积、缺乏管理可以导致巨大危害,故强调"重管理"理念。以女性癫患者为中心,充分考虑其个体化需求,关注整个治疗过程,制定长期随访计划,在控制癫发作的同时,尽可能减少药物不良反应并降低共患病的发生。     

视频脑电图在小儿癫痫诊断中的应用

目的评价视频脑电图(video-EEG)在小儿癫诊断中的应用价值。方法对126例具有发作性症状的患儿进行连续8h的包括清醒、睡眠、诱发试验及必要的认知测验的视频脑电图监测。结果经发作期视频脑电图证实,39例初诊为癫性发作的患儿中14例(35%)为非癫性发作;15例其他症状发作中13例(86%)为非癫性发作。64例样放电患儿中51例(80%)确定发作类型,22例(34%)确定癫类型。视频脑电图可发现短暂轻微的癫发作及样放电引起的一过性认知损伤。结论视频脑电图在排除非癫性发作、确定癫性发作的类型、评价脑电-临床关系方面可提供准确可靠的证据,进一步提高癫的临床诊断水平。     

女性与青少年癫

癫是常见的神经系统疾病,全球发病率和患病率呈逐渐上升趋势。女性和青少年癫患者是占相当患病比例的特殊群体,具有性别或年龄相关的疾病特点及诊断与治疗要点,如女性患者面临的生育问题、青少年患者面临的发育问题,均导致二者在抗癫药物选择、治疗策略制定、疾病预后评价等方面存在特殊性,准确把握女性和青少年癫的诊断与治疗要点,对有效控制癫发作、降低癫相关并发症风险和减少药物不良反应具有重要意义。     

脑梗死后癫诊治体会

目的探讨脑梗死继发癫的临床特点,为其诊治提供帮助。方法对386例脑梗死继发癫患者32例进行临床分析。结果皮层损害者发作癫几率高于皮层下损害,癫发生的几率在梗死灶≥4cm与<4cm患者中无显著性差异。结论脑梗死继发癫几率与梗死灶位置相关,与梗死灶大小关系不密切。     

认知功能评定方法在癫中的应用

癫是一种慢性疾病,因其疾病的特殊性质及抗癫药物的长期应用,患者常合并有程度不等的认知功能障碍。认知功能是癫的重要预后指标之一,对认知功能障碍程度的评定既可用于判断预后和指导康复治疗,也可为相关临床科研工作提供统一量化、有较好可比性的数据。对癫患者的认知功能评定越来越引起临床和科研工作者的注意,2011年国际抗癫联盟(ILAE)发布了癫神经心理并发症的治疗指南,其中包括癫相关的认知功能异常评估和处理指南,强调应向癫患者及家属宣教认知功能的相关知识,并应由专业的临床神经心理学者对癫患者进行认知功能评定。本文复习癫认知评定方法的有关文献,对近年在此方面的研究作介绍。     

儿童良性中央回-颞区棘波灶癫(痫)与注意网络间的相关研究

儿童良性中央-颞区棘波灶癫(BECTS)是一种与睡眠密切相关的、最常见于儿童的癫综合征之一。研究认为,BECTS存在认知功能障碍,特别是注意功能方面。本文综述此类型癫患儿的注意功能损害的研究进展。     

幕上胶质瘤致癫相关因素分析

目的探讨幕上胶质瘤致癫相关因素。方法回顾性分析175例幕上胶质瘤病人的临床资料,其中伴发癫51例(29.1%);并对肿瘤部位、影像学特点、侵犯皮质及病理类型等致癫相关因素进行统计分析。结果额叶胶质瘤癫发生率明显高于其他部位胶质瘤(P0.01),少枝胶质细胞瘤及低级别星形细胞瘤易于发生癫(P0.017),肿瘤侵犯皮质病人癫发生率明显高于未侵犯皮质者(P=0.01)。结论幕上胶质瘤伴发癫与肿瘤所在部位、病理类型及侵犯皮质相关。对于此类病人不仅需手术切除肿瘤,还应控制癫发作,减少并发症,提高生存质量。     

难治性癫(癎)发病与突触机制紧密相关的生物分子研究

癫是一种常见的慢性神经系统疾病,全球约5 000万患者。系统正规地使用抗癫药物治疗后大部分患者可获得长期缓解,但仍有20%～30%患者癫发作不能得到有效控制,成为难治性癫[1]。难治性癫对于患者身心造成严重影响,其发病机制仍不清楚。自20世纪90年代日本学者发现癫患者脑组织中存在与突触功能相关的基因存在     

脑动静脉畸形患者癫发作的相关因素分析

目的探讨脑动静脉畸形并发癫发作的相关危险因素以及癫的合理预防措施。方法回顾性分析286例脑动静脉畸形患者的临床及脑动静脉畸形基线资料。根据是否合并癫发作分为癫组和对照组。分析脑动静脉畸形患者并发癫发作的危险因素,观察癫组92例患者的发作类型及发作频率以及药物治疗反应情况。结果癫组与对照组畸形血管团的位置、畸形血管团直径、静脉引流方向等因素比较差异明显(P0.05);非条件多因素Logistic回归分析显示对脑动静脉畸形患者癫发作有显著影响的因素为畸形团直径大于3 cm和由浅静脉或者浅深静脉共同引流(P0.05)。经过抗癫药物治疗,癫组有69例患者癫发作得到了完全控制,余患者发作频率均有不同程度减低。结论畸形团直径大于3cm和由浅静脉或者浅深静脉共同引流是脑动静脉畸形患者并发癫的危险因素;脑动静脉畸形合并的癫发作是一个相对良性过程,抗癫药物对多数癫患者治疗有效。     

Sleep and epilepsy

The intimate relationship between sleep and epilepsy has long been recognized, yet our understanding of the relationship is incomplete. In this article we address four key issues in this area. First, we consider the reciprocal interaction between sleep and epilepsy. Sleep state clearly influences seizure onset, particularly in certain epilepsy syndromes. The converse is also true; epilepsy may disrupt sleep, either directly through seizures and epileptiform activity, or indirectly through medication-related effects. Unraveling the influences of sleep stage, epilepsy syndrome, and drug effects is challenging, and the current state of knowledge is reviewed. Secondly, accurate diagnosis of sleep-related epilepsy can be difficult, particularly the distinction of nocturnal frontal lobe epilepsy (NFLE) from arousal parasomnias. The challenges in this area, along with work from the authors, are discussed. Thirdly, we will explore the putative relationship between obstructive sleep apnea (OSA) and epilepsy, including the effect of OSA on quality of life; this will lead us to a brief exploration of the effects of OSA on neuroendocrine function. Finally, we will review the evidence surrounding the role of sleep in sudden unexpected death in epilepsy (SUDEP).This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.     

Validation of actigraphy with continuous video-electroencephalography in children with epilepsy

BackgroundThe relationship between epilepsy and sleep is bidirectional as seizures disrupt sleep and coexisting sleep disorders have detrimental effects on seizure control and quality of life for both the children and their families. Previous research has reported on sleep disturbance in children with epilepsy primarily by subjective parental reports. Actigraphy may provide a more accurate objective evaluation of sleep, but the validity of this sleep measure for children with epilepsy has not yet been assessed. The primary objective of this study was to validate the use of actigraphy as a tool in studying sleep patterns in children with epilepsy.MethodsThis was a prospective study comparing sleep and wake epochs recorded for 24 h simultaneously by actigraphy and by continuous video-electroencephalography (VEEG) monitoring in 27 patients aged 2–18 years with medically refractory epilepsy.ResultsStrong correlations were found between actigraphy and VEEG sleep variables including night sleep period (r = 0.99), night sleep time (r = 0.96), duration of night wake time (r = 0.93) and number of significant wakings during the night (r = 0.81).ConclusionThe study results validate that actigraphy is a reliable and objective clinical and research tool for evaluating sleep and wakefulness in children with epilepsy.     

Sleep and epilepsy: Exploring an intriguing relationship with a translational approach

The relationship between sleep and epilepsy has been well established. There is a high prevalence of sleep disturbances in epilepsy, which are associated with a decreased quality of life of individuals with epilepsy. In view of this fact, preclinical research is necessary to address many gaps in knowledge. For instance, it is well known that sleep deprivation can trigger seizures; however, this is a complex pathophysiological event. In this context, there are many valuable animal models of epilepsy that reproduce clinical symptoms and can be used. Investigations using animal models that simulate clinical epilepsy are imperative. Furthermore, preclinical studies that reveal mechanisms related to sleep–epilepsy interactions are very important. Results of such studies can, in turn, improve the understanding of epilepsy itself and can be useful in developing new antiepileptic drugs and preventive measures to control seizures. Preclinical research should be performed using a translational framework with experimental designs that can lead to advances in the quality of life of individuals with epilepsy. In view of the fact that more than 50 million of people are affected by epilepsy around the world, understanding the relationship between sleep and epilepsy is imperative.This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.     

Daytime behavior and sleep disturbance in childhood epilepsy

The purpose of this research is to further explore the relationship between sleep disturbance and daytime behavior in children with epilepsy. Parent-rating questionnaires and child symptom self-report measures were employed to evaluate daytime behavior in 30 children with epilepsy and sleep-disordered symptoms. Overnight polysomnography was used to assess for nocturnal sleep problems such as obstructive sleep apnea, nocturnal seizures, periodic leg movements, and sleep fragmentation. We hypothesized that children with epilepsy would exhibit both clinically significant behavioral and sleep problems. Results indicate that 80% of children with epilepsy exhibited sleep disruption because of either clinically significant obstructive apnea syndrome, disturbance of sleep architecture, or sleep fragmentation. These findings further suggest that daytime behavior problems encountered in children with epilepsy may be attributed to specific disruptions in sleep regulation.     

The sleep–wake cycle in adult rats following pilocarpine-induced temporal lobe epilepsy

The relationship between sleep and epilepsy is both complex and clinically significant. Temporal lobe epilepsy (TLE) influences sleep architecture, while sleep plays an important role in facilitating and/or inhibiting possible epileptic seizures. The pilocarpine experimental model reproduces several features of human temporal lobe epilepsy and is one of the most widely used models in basic research. The aim of the present study was to characterize, behaviorally and electrophysiologically, the phases of sleep–wake cycles (SWC) in male rats with pilocarpine-induced epilepsy. Epileptic rats presented spikes in all phases of the SWC as well as atypical cortical synchronization during attentive wakefulness and paradoxical sleep. The architecture of the sleep–wake phases was altered in epileptic rats, as was the integrity of the SWC. Because our findings reproduce many relevant features observed in patients with epilepsy, this model is suitable to study sleep dysfunction in epilepsy.     

Focal Sleep Spindle Deficits Reveal Focal Thalamocortical Dysfunction and Predict Cognitive Deficits in Sleep Activated Developmental Epilepsy

Childhood epilepsy with centrotemporal spikes (CECTS) is the most common focal epilepsy syndrome, yet the cause of this disease remains unknown. Now recognized as a mild epileptic encephalopathy, children exhibit sleep-activated focal epileptiform discharges and cognitive difficulties during the active phase of the disease. The association between the abnormal electrophysiology and sleep suggests disruption to thalamocortical circuits. Thalamocortical circuit dysfunction resulting in pathologic epileptiform activity could hinder the production of sleep spindles, a brain rhythm essential for memory processes. Despite this pathophysiologic connection, the relationship between spindles and cognitive symptoms in epileptic encephalopathies has not been previously evaluated. A significant challenge limiting such work has been the poor performance of available automated spindle detection methods in the setting of sharp activities, such as epileptic spikes. Here, we validate a robust new method to accurately measure sleep spindles in patients with epilepsy. We then apply this detector to a prospective cohort of male and female children with CECTS with combined high-density EEGs during sleep and cognitive testing at varying time points of disease. We show that: (1) children have a transient, focal deficit in spindles during the symptomatic phase of disease; (2) spindle rate anticorrelates with spike rate; and (3) spindle rate, but not spike rate, predicts performance on cognitive tasks. These findings demonstrate focal thalamocortical circuit dysfunction and provide a pathophysiological explanation for the shared seizures and cognitive symptoms in CECTS. Further, this work identifies sleep spindles as a potential treatment target of cognitive dysfunction in this common epileptic encephalopathy.SIGNIFICANCE STATEMENT Childhood epilepsy with centrotemporal spikes is the most common idiopathic focal epilepsy syndrome, characterized by self-limited focal seizures and cognitive symptoms. Here, we provide the first evidence that focal thalamocortical circuit dysfunction underlies the shared seizures and cognitive dysfunction observed. In doing so, we identify sleep spindles as a mechanistic biomarker, and potential treatment target, of cognitive dysfunction in this common developmental epilepsy and provide a novel method to reliably quantify spindles in brain recordings from patients with epilepsy.     

Sleep behavior disturbances in rolandic epilepsy

The relationship between specific epilepsy syndromes and particular sleep symptoms has not been well delineated. The authors' aim was to test the hypothesis that children with rolandic epilepsy exhibit more frequent sleep problems and daytime sleepiness compared with children without epilepsy. They compared parent-reported sleep behaviors of 43 children with rolandic epilepsy aged 6 to 16 years recruited from 5 US pediatric neurology centers with a historical reference and sleep clinic sample using the Child Sleep Habits Questionnaire. The authors compared the differences in mean frequency of sleep problems and patterns. Total Children's Sleep Habits Questionnaire scores were significantly higher (P < .001) in the rolandic epilepsy sample than reference. Parents of children with rolandic epilepsy reported a significantly shorter sleep duration (P < .006), more frequent parasomnias (P < .008), and increased daytime sleepiness (P < .001). Thus, parents of children with rolandic epilepsy reported more problematic sleep and daytime impairment compared with a reference sample of children.     

Sleep-related epilepsy

Sleep is important for the general health of all, but is particularly essential for individuals with epilepsy. In these patients, a complex relationship exists between seizures and sleep, and both must be considered for optimal care. In this review, recent advances in the field of epilepsy and sleep are considered. These include sleep disorders with a specific relationship to epilepsy, the influences of sleep and sleep deprivation on interictal epileptiform discharges, detrimental effects of seizures on sleep, and the effects (good and bad) of epilepsy treatments on sleep.     

Sleep and epilepsy

The relationship of sleep and epilepsy demonstrates the delicate association of brain physiology and dysfunction. Sleep affects the distribution and frequency of epileptiform discharges in humans and influences the rate of kindling in animals. Epileptic discharges, on the other hand, alter sleep regulation and provoke sleep disruption. This effect on sleep appears to carry over to sleep complaints in patients with epilepsy. Individuals with epilepsy frequently complain of symptoms suggestive of disturbed sleep, such as excessive daytime sleepiness, insomnia, or with more subtle complaints such as an increase in seizure frequency. More commonly, these symptoms indicate an underlying sleep disorder rather than the effect of epilepsy or medication on sleep. Clinicians must be able to identify and differentiate between potential sleep disorders and sleep dysfunction related to epilepsy and direct therapy to improve the patient's symptoms. The reciprocal relationship of sleep and epilepsy and the management of sleep complaints in the patient with epilepsy will be reviewed.