Picard F, Mégevand P, Minotti L, Kahane P, Ryvlin P, Seeck M, Michel C M, Lantz G
Department of Neurology, University Hospital and Medical School of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
Clin Neurophysiol. 2007 Apr;118(4):928-39. doi: 10.1016/j.clinph.2006.12.014. Epub 2007 Feb 20.
Nocturnal frontal lobe epilepsy (NFLE) seizures occur primarily during non-rapid eye movement sleep stage 2. We observed in several patients rhythms of same localization and frequency as sleep spindles, immediately preceding and sometimes continuing at seizure onsets. We aimed to study the link between sleep spindles and seizure onsets.
We used intracerebral stereo-EEG ictal recordings of two MRI-negative patients with clinically defined NFLE. For each of the six studied seizures, sustained activity in the frontal sleep spindle frequency (12Hz) was observed around seizure onset. The duration of this pre-seizure sleep spindle was compared to that of the 10 preceding sleep spindles.
The pre-seizure sleep spindles were clearly of longer duration than the "interictal" sleep spindles for all seizures. This sustained pre-seizure 12Hz activity could be differentiated from normal awakenings, and showed no spatial relation to the ictal onset.
We demonstrated a functional alteration of the sleep spindle-generating thalamocortical loop concomitant with the seizure onsets. This defect may also be involved in seizure generation.
A thalamic participation in NFLE pathogenesis is likely in our two patients. The study of additional patients will allow to evaluate the role of the thalamocortical circuits in NFLE.
夜间额叶癫痫（NFLE）发作主要发生在非快速眼动睡眠的2期。我们在几名患者中观察到，在癫痫发作开始前，有时在发作期间，出现了与睡眠纺锤波定位和频率相同的节律。我们旨在研究睡眠纺锤波与癫痫发作起始之间的联系。
我们使用了两名临床确诊为NFLE的MRI阴性患者的脑内立体脑电图发作期记录。对于所研究的6次发作中的每一次，在癫痫发作开始时观察到额叶睡眠纺锤波频率（12赫兹）的持续活动。将发作前睡眠纺锤波的持续时间与之前10个睡眠纺锤波的持续时间进行比较。
所有发作的发作前睡眠纺锤波的持续时间明显长于“发作间期”睡眠纺锤波。这种发作前持续的12赫兹活动可与正常觉醒区分开来，且与发作起始无空间关系。
我们证明了与癫痫发作起始同时存在的睡眠纺锤波产生丘脑皮质环路的功能改变。这种缺陷也可能参与癫痫发作的产生。
在我们的两名患者中，丘脑可能参与了NFLE的发病机制。对更多患者的研究将有助于评估丘脑皮质回路在NFLE中的作用。
