Kobayashi K, Ohtsuka Y, Ohtahara S
Department of Child Neurology, Okayama University Medical School.
No To Hattatsu. 1990 Mar;22(2):136-42.
There are numerous important problems concerning relationship between epilepsy and sleep. To clarify the clinical significance and pathophysiology of the nonconvulsive status epilepticus with continuous diffuse spike-waves during slow-wave sleep (CSWS) in EEG, this study was carried out on seven cases each of epilepsies with electrical status epilepticus during slow sleep (ESES) and with peculiar type of nonconvulsive status epilepticus in childhood (PNSE) and four cases of atypical benign partial epilepsy (ABPE). Mental deterioration was most frequently observed in ESES, less in PNSE but none in ABPE. In both ESES and PNSE, mentally deteriorated cases showed suppression of CSWS at significantly later ages than those without deterioration. And spike-wave indices during slow-wave sleep, which were the highest in ESES and lower in PNSE and ABPE, also had a strong relation to mental deterioration. In these three disorders, both clinical seizures and CSWS were suppressed at or before 16 years of age, although they were intractable before adolescence. This finding indicated age dependent evolutions of the three disorders. Coherence and phase analysis of CSWS was undertaken to differentiate primary and secondary bilateral synchrony in seven cases of these three disorders, which have both features of generalized and partial epilepsies. This analysis disclosed secondary bilateral synchrony as the nature of CSWS in six cases. And this analysis method was considered to provide a clue to their pathophysiology. Thus, in these disorders, importance of early diagnosis by EEG including deep sleep and early treatment was recognized.
癫痫与睡眠之间的关系存在许多重要问题。为了阐明脑电图中慢波睡眠期持续弥漫性棘波的非惊厥性癫痫持续状态（CSWS）的临床意义和病理生理学，本研究对7例慢睡眠期电惊厥性癫痫持续状态（ESES）和7例儿童特殊类型非惊厥性癫痫持续状态（PNSE）以及4例非典型良性部分性癫痫（ABPE）进行了研究。精神衰退在ESES中最常见，在PNSE中较少见，而在ABPE中则无。在ESES和PNSE中，精神衰退的病例出现CSWS抑制的年龄明显晚于未衰退的病例。慢波睡眠期的棘波指数在ESES中最高，在PNSE和ABPE中较低，也与精神衰退密切相关。在这三种疾病中，尽管在青春期前难以控制，但临床发作和CSWS在16岁及之前均得到抑制。这一发现表明这三种疾病存在年龄依赖性演变。对这三种疾病的7例患者进行了CSWS的相干性和相位分析，以区分原发性和继发性双侧同步性，这三种疾病同时具有全身性和部分性癫痫的特征。该分析揭示6例患者的CSWS本质为继发性双侧同步性。并且认为这种分析方法为它们的病理生理学提供了线索。因此，在这些疾病中，认识到包括深度睡眠脑电图在内的早期诊断和早期治疗的重要性。
