Centre of Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, 69004 Lyon France; NeuroPain Team, Inserm U 1028/CNRS, UMR 5292, University of Lyon, Lyon Neuroscience Research Centre (CRNL), 69677 Bron, France; Faculty of Medecine Lyon Sud, University Lyon 1, 69310 Pierre-Bénite, France.
Centre of Functional Neurology and Epileptology, Neurological Hospital, Hospices Civils de Lyon, 69677 Bron, France.
Neurophysiol Clin. 2018 Oct;48(5):277-286. doi: 10.1016/j.neucli.2018.08.002. Epub 2018 Sep 15.
Differential diagnosis between sleep-related epileptic seizures and NREM parasomnia remains challenging. Pathophysiological markers to differentiate both conditions are needed. Activation of autonomic system is present in arousal reactions and epileptic seizures. Our study investigated whether cardiac reactivity differed between arousal disorders and sleep-related seizures.
Nocturnal recordings of 50 patients (10 in each group: frontal lobe epilepsy [FLE], temporal lobe epilepsy [TLE], nocturnal terror [NT], confusional arousal [CA], normal arousals [NA]) were retrospectively selected. Timing of the first motor sign and description of behaviours were assessed. Beat-to-beat RR intervals (RRI) as well as heart rate variability were analysed over a period of 60 heartbeats before and after first motor manifestation. The slope and area under the curve (AUC) of RRI were calculated.
A significant decrease in RRI was observed at the onset of all events. Statistical analysis revealed: lower RRI in TLE than in other groups; higher slope of RRI in FLE than in NA and TLE, and higher AUC in NT and FLE than in TLE, and in NT than in NA. Sleep stage, episode duration, vocalization characteristics, lateralized or abnormal posture, exploratory behaviour differed between epileptic and parasomnia groups.
Analysis of cardiac reactivity seems to be a useful objective tool, together with clinical features, for diagnosing abnormal behaviour during sleep. Cardiac reactivity in TLE could reflect epileptic discharge propagation to brain areas involved in autonomic control, while FLE and NT might involve a strong non-specific activation of the sympathetic system.
睡眠相关癫痫发作与非快速眼动期（NREM）睡眠障碍的鉴别诊断仍然具有挑战性。需要有鉴别这两种疾病的病理生理标志物。自主神经系统的激活存在于觉醒反应和癫痫发作中。我们的研究旨在探讨觉醒障碍和睡眠相关癫痫发作之间的心脏反应是否存在差异。
回顾性选择了 50 名患者（每组 10 名：额叶癫痫[FLE]、颞叶癫痫[TLE]、夜间恐怖症[NT]、意识模糊性觉醒[CA]、正常觉醒[NA]）的夜间记录。评估了第一个运动征象的时间和行为描述。在第一个运动表现之前和之后的 60 个心跳周期内分析了逐搏 RR 间期（RRI）和心率变异性。计算了 RRI 的斜率和曲线下面积（AUC）。
所有事件的起始均观察到 RRI 的显著降低。统计分析显示：TLE 的 RRI 低于其他组；FLE 的 RRI 斜率高于 NA 和 TLE，NT 和 FLE 的 AUC 高于 TLE，NT 的 AUC 高于 NA。癫痫组和睡眠障碍组之间的睡眠阶段、发作持续时间、发声特征、侧化或异常姿势、探索行为存在差异。
心脏反应分析似乎是一种有用的客观工具，与临床特征一起，可用于诊断睡眠期间的异常行为。TLE 中的心脏反应可能反映了癫痫放电向参与自主控制的大脑区域传播，而 FLE 和 NT 可能涉及交感神经系统的强烈非特异性激活。
