自然夜间睡眠脑电图对癫痫的诊断价值

目的：观察自然夜间睡眠脑电图（ＥＥＧ）对癫痫的诊断价值，方法；对２００例临床拟诊为癫痫的患者行白昼常规ＥＥＧ和夜间自然睡眠ＥＥＧ，结果：常规ＥＥＧ３６％（７２例）出现痫样放电，而自然夜间睡眠ＥＥＧ７８％（１５６例）出现痫样放电，痫样波检出率与年龄，临床发作类型，睡眠周期有关。结论：自然夜间睡眠ＥＥＧ可显著地提高痫样放电的检出率，对癫痫的诊断与鉴别诊断有重要的参考价值。     

癫痫患者睡眠感知误差与睡眠结构的关系

目的 探讨癫痫患者睡眠感知误差与睡眠结构的关系。方法 收集102例癫痫患者,比较 低估睡眠时间组、评估基本准确组、高估睡眠时间组间睡眠结构的差异。结果 78%的癫痫患者存在睡 眠感知误差,低估者占35%,高估者占43%。与评估基本准确组比较,低估组伴有强直-阵挛发作的比例 更高。在高估组、评估基本准确组、低估组间,N1+2期脑电醒觉指数依次趋于增大;与评估基本准确组比较, 高估组N3 期觉醒比例增大。结论 大多数癫痫患者存在睡眠感知误差,伴有强直-阵挛发作者趋于低估 睡眠时间。癫痫患者的睡眠感知误差与睡眠不稳定性有关;其中,低估睡眠时间与N1+2 期睡眠不稳定性 增加有关,高估睡眠时间与N3期睡眠不稳定性增加有关。     

抗癫痫药物对癫痫患者睡眠结构的影响

抗癫痫药物都会在一定程度上影响癫痫患者的睡眠,目前研究趋向于新型抗癫痫药物对患者睡眠的影响更小。本文按照临床应用的时间顺序简要综述了常用的抗癫痫药物对癫痫患者睡眠结构的影响。     

剥夺睡眠与睡眠诱发试验脑电图对不同类型癫痫的作用

目的：探讨诱发试验脑电图与不同类型癫痫的关系及临床意义。方法：对９８例临床确诊的癫痫患者分别进行常规脑电图检查和剥压睡眠诱发及睡眠诱发脑电图试验,比较三次结果的异常率和棘波出现率。结果：睡眠与剥夺睡眠诱发试验均可提高脑电图的异常率和棘波出现率,均可提高全身性强直阵挛发作、复杂部分性发作和失神发作等类型癫痫的棘波出现率,录夺睡眠诱发还可提高简单部分发作棘波的出现率,而对多种类并存者和不能分类者均无意义。结论：诱发试验提高棘波出现率不仅与诱发方法有关,而且与癫痫的发作类型有关。     

抗癫痫药对癫痫患者睡眠结构的影响

目前对于癫痫的研究发现,癫痫患者存在睡眠障碍问题,此可归因于抗癫痫药本身、癫痫发作和不规律的睡眠等方面〔1〕,其中抗癫痫药对癫痫患者睡眠结构的影响不可忽视,纠正癫痫患者的睡眠障碍有助于癫痫的治疗〔2〕。1.睡眠多导监测介绍1953年,Aserinsky等在记录脑电的同时记录到了眼球的运动,发现了快速眼动期睡眠(REM),从而推动了睡眠多导监测技术的发展。多导睡眠仪(PSG)的应用开始于20世纪80年代。装备有直流信号处理器:处理呼吸气流、呼吸运动和血氧饱和度信号;②交流信号处理器:处理脑电、眼动、心电和肌电信号。根据脑电、眼球运动和肌电表现,可以将睡眠分成非快眼动睡眠(NREM)和快眼动睡眠(REM),NREM睡眠又可进一步分为1、2、3、4期。目前使用的PSG大多配有视频录像系统,可以同时捕捉患者的夜间睡眠情况。2.睡眠生理⑴睡眠结构:正常睡眠是由NREM睡眠与REM睡眠两个不同睡眠时相构成。NREM睡眠分为1、2、3、4期,NREM睡眠的3期和4期合称慢波睡眠(SWS)。REM睡眠又称快波睡眠。在整个睡眠过程中,NREM睡眠与REM睡眠交替出现。以正常成人8小时睡眠为例,一开始首先进入NREM睡眠期,并迅...     

100例癫痫病人的剥夺睡眠诱发脑电图分析

目的探讨剥夺睡眠诱发法是否可提高癫痫病人脑电图癫痫样波的阳性率.方法对临床拟诊为癫痫,常规脑电图描记正常的100例病人行剥夺睡眠诱发试验,并选择46例正常人作对照.结果 100例癫痫病人剥夺睡眠诱发脑电图呈现爆发性癫痫样波者42例(42%),46例正常人脑电图无1例呈爆发波,两组相比有显著差别(P＜0.001).结论脑电图有轻度改变者,剥夺睡眠诱发试验可提高癫痫病人脑电图癫痫样波的阳性率.     

日间睡眠脑电图在癫痫诊断中的应用

目的：探讨睡眠脑电图（ＥＥＧ）在癫痫诊断中的价值及适应症。方法：过去１０年间５２２例患有癫痫及各种发作性疾患病人的睡眠及清醒ＥＥＧ进行研究。结果：ＥＥＧ有异常爆发活动（ＰＡ）者２１７例，ＰＡ只在睡眠中出现者９６例，痫样放电的检出率由清醒的２３．２％提高到４１．６％。１５例病人通过发作间期或发作期的睡眠ＥＥＧ显示的ＰＡ，进一步明确癫痫发作类型。在９７例有中央－－颞棘波的儿童良性部分性癫痫中，５０例（     

剥夺睡眠对颞叶癫痫的检测

目的对常规脑电图正常的颞叶癫痢病人进行剥夺睡眠诱发。方法常规脑电图检查每人2次以上正常者，再进行剥夺睡眠诱发试验。结果颞区以癫痫综合波出现为主，单侧多于双侧，左侧多于右侧，以灶性阵发。癫痫波出现时间在思睡期-睡眠I期、睡眠Ⅱ期以后癫痫波逐渐减少至消失。结论剥夺睡眠诱发对癫痫尤其是颞叶癫痫及常规脑电图正常的癫痫者是一种非常有效的检测方法，还可对将要减药或停药的癫痫病人进行监测。     

Structure of the spontaneous all night sleep in epileptics with polysomnography.

Twenty epileptics and 11 healthy controls were investigated with polysomnography. Epileptics with interictal discharges had significantly longer total recording time and longer REM latency than the controls (P<0.05). Epileptics had a more fragmentized sleep than controls. Sleep efficiency of patients with interictal discharges was lower than that of patients without them (P<0.05). Among the patients with interictal discharges, those with partial seizures had a significantly higher arousal number than those with generalized seizures (P<0.05). The number of NREM stage shifts in patients with partial seizures tended to be higher than in those with generalized seizures.     

Estradiol treatment modulates spontaneous sleep and recovery after sleep deprivation in castrated male rats

Exogenous estradiol (E) is used occasionally to treat the side effects associated with androgen-deprivation in men, but its effects on sleep patterns have received little attention. We examined whether E modulates sleep patterns and recovery from sleep loss in castrated male rats. Adult male rats were castrated and implanted subcutaneously with Silastic tubes containing either oil (Cast + Oil) or E (Cast + E). Sham-operated male rats (Intact) were implanted with oil-filled tubes. All rats were also implanted with EEG and EMG electrodes for sleep/wake recordings. After two weeks, polysomnographic recordings were made before, during, and following 6 h of sleep deprivation (SD). At baseline, the Cast + Oil group showed sleep and EEG patterns similar to those in the Intact group. Compared to these groups, the Cast + E group spent more time awake during the dark (active) phase, and showed higher EEG theta power (a measure of cortical activation) during wake and rapid eye movement (REM) sleep in both the light and dark phases. Following SD, the Cast + E group showed a larger increase from baseline in REM sleep amount, compared to the Cast + Oil group. The Cast + Oil group showed prolonged rebound in non-REM sleep and EEG delta power, and reduced REM sleep rebound, compared to the other two groups. These results indicate that E treatment in castrated male rats promotes baseline wakefulness during the active phase, and facilitates recovery of REM sleep after acute sleep loss. The possible benefit of E treatment for improving sleep quality in androgen-deprived men remains to be investigated.     

剥夺睡眠脑电图在癫诊断中的应用

目的 分析睡眠脑电图(EEG)在癫诊断中的价值及适应证.方法 对200例癫病人的睡眠及清醒脑电图进行研究.结果 脑电图有异常爆发活动(PA)者80例,PA只在睡眠中出现者30例,样放电检出率由清醒的25%提高到睡眠的40%.结论 睡眠脑电图对提高样放电的检出率和进一步明确癫发作类型有重要意义.     

Chlorpromazine versus sleep deprivation in activation of EEG in adult-onset partial epilepsy

We prospectively compared the activating effect of chlorpromazine (CHLP, 50mg, i.m.) versus sleep deprivation (SD) in 41 patients with a clinical diagnosis of partial epilepsy. Patients were selected on the basis of both seizure onset in adulthood and normal interictal awake EEG recordings. Twenty out of 41 patients (group A) were not yet treated because of either recent onset of epilepsy or misdiagnosis. The remaining 21 patients (group B) were treated with antiepileptic drugs (AED). A control group consisted of 18 healthy volunteers (group C). All EEG recordings were scored by one observer according to a fixed protocol. In group A, SD and CHLP activated sleep EEG in 12 (60%) and 19 (95%) patients, respectively. This difference reached the limit of statistical significance (P=0.05, McNe-mar test). In group B, SD and CHLP activated sleep EEG in 12 (57%) and 13 (62%) patients respectively. There was a significant (P<0.02, exact Fisher test) intergroup difference (95% vs 62%) with respect to the activating effect of CHLP No false-positive results were found in 18 control subjects. SD or CHLP activating procedures did not provoke any epileptic seizures in any of the groups. In conclusion, EEG activation by either SD or CHLP is highly specific in the diagnosis of adult-onset partial epilepsy. Moreover, CHLP is more sensitive than SD in untreated patients, whereas the activating effect of CHLP may be partially attenuated by AED.     

Effects of sleep loss on sleep architecture in Wistar rats: gender-specific rebound sleep

This study was designed to examine the influence of gender on sleep rebound architecture after a 4-day paradoxical sleep deprivation period. After a 5-day baseline sleep recording, both male and female rats in different phases of the estrus cycle were submitted to paradoxical sleep deprivation for 96 h. After this period, the sleep rebound recording was evaluated for 5 days (one estrus cycle). The findings revealed that after paradoxical sleep deprivation, sleep efficiency and paradoxical sleep returned to baseline values on the second day of the light period, for all except the proestrus group. During the dark rebound period, only the female groups presented increased sleep efficiency on the first day. Paradoxical sleep returned to baseline values on the third day, except for males and the cycling females submitted to paradoxical sleep deprivation in the diestrus phase, whose baseline values returned to normal on the second day of rebound period. Thus, the females and males displayed distinct patterns as a result of sleep disruption.     

Sleep related epilepsy in focal cortical dysplasia type 2: Insights from sleep recordings in presurgical evaluation

ObjectiveTo determine the relationship between seizure onset, sleep stage and focal cortical dysplasia type 2 (FCD2) location in sleep related epilepsy (SRE).MethodsWe reviewed scalp video-EEG data of 77 patients with SRE among 130 surgically treated patients with histologically confirmed FCD2. Seizure onset was classified as occurring during NREM, REM and after arousal.ResultsSleep recordings were available for 65 patients (37 males, 7–49 years old). FCD2 was located in frontal lobe in 46 (71%) and in extra-frontal regions in 19, including the temporal lobe in 6. MRI was negative/doubtful in 35 cases. Interictal rhythmic/pseudorhythmic spike rate increased from 31% during waking to 65% during sleep. Seizure onset occurred from NREM in 46 cases (71%), mostly from stage 2, and after arousal in 14 (22%). Seizures occurring from NREM/REM sleep were significantly more frequent in frontal (89%) compared to extra-frontal location (42%), whilst arousal preceded seizure onset more often in extra-frontal (58%) compared to frontal location (7%).ConclusionsNREM seizure onset is the most common ictal pattern in SRE due to frontal FCD2 whereas preceding arousal points to extra-frontal regions.SignificanceSleep recordings may help for FCD2 localisation and suggest topography dependent impact on sleep related epileptic networks.     

A comparative study of the diagnostic value of drug-induced sleep EEGs and sleep EEGs following sleep deprivation in patients with complex partial seizures

Summary The purpose of the study was to investigate whether the sleep EEG after sleep deprivation has a stronger provocative effect than the drug-induced sleep EEG. For this purpose a sleep EEG, induced by 2 mg/kg body weight of promazine hydrochloride, was recorded. On the following day a sleep EEG of the same patient was recorded after sleep deprivation of 24–26 h. If only patients whose wake EEGs were free from epileptic activity are considered, the rate of provocation was 58%. As epileptic activity could be recorded even in the sleep EEG without sleep deprivation in 45%, the advantage gained by recording a sleep EEG after sleep deprivation (52%) is only relatively small. The occurrence of epileptic activity was shown to be significantly more frequent amongst women and those who developed epilepsy at a younger age. For practical purposes it is recommended that for those patients whose wake EEGs are free from epileptic activity, a sleep EEG—possibly drug-induced—should be recorded. Only in instances where epileptic activity can not then be recorded should a wake EEG after sleep deprivation be carried out, and followed immediately, if necessary, by a sleep EEG.Supported by the Deutsche Forschungsgemeinschaft     

脑梗死分型与睡眠结构的相关研究

目的探讨不同类型脑梗死患者睡眠结构的差异及睡眠结构改变与睡眠障碍及抑郁发生的相关性。方法入组258例为收入本院的脑梗死患者,进行睡眠评价及多导睡眠监测,分析不同组别患者各睡眠参数的差异、各睡眠参数与睡眠障碍评分及抑郁评分的相关性、各组患者抑郁的发生率。结果 4组患者睡眠结构的差异均明显(P0.05),组间比较皮层梗死组及脑干梗死组患者较其他2组患者均不同程度表现出觉醒时间、NREM1+2期延长及NREM3+4期及REM期缩短(P0.05)。PSQI评分、HAMD评分与微觉醒指数、NREM1+2期呈线性正相关(r0,P0.05),与NREM3+4、REM期期呈线性负相关(r0,P0.05)。4组患者抑郁的发生率比较无明显差异(P0.05)。结论皮层下病变更容易出现睡眠结构紊乱,而睡眠结构的改变与睡眠障碍评分及脑梗死后抑郁评分有关,脑梗死后早期患者睡眠结构的改变可能更为明显。     

精神分裂症的睡眠脑电图研究进展

精神分裂症是一组病因未明的精神疾病,多起病于青壮年,常有感知、思维、情感、行为等多方面的障碍和精神活动不协调,病程多迁延［1］。睡眠障碍往往是精神分裂症的先兆症状和伴随症状,睡眠质量的好坏也常常影响病情的转归［2］。多导睡眠图（Polysomnogram ,PSG ）是评估睡眠质量的重要手段,可以用来探讨药物、心理治疗、物理治疗等治疗手段对睡眠的影响［3］。既往研究对精神分裂症患者睡眠脑电图的改变进行了探讨,主要包括睡眠结构、慢波睡眠（SWS ）、睡眠纺锤波、K 复合波和睡眠δ波,希望找到精神分裂症患者睡眠参数的改变与神经生理学、精神病理学之间的关系,继而确定睡眠脑电图改变与精神分裂症之间的相关性,找到精神分裂症的生物学标记,为精神分裂症的诊断和治疗提供依据。