广义多尖峰串：耐药性特发性全面性癫痫的 EEG 生物标志物。
Generalized polyspike train: An EEG biomarker of drug-resistant idiopathic generalized epilepsy.
机构信息
From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia.
出版信息
Neurology. 2018 Nov 6;91(19):e1822-e1830. doi: 10.1212/WNL.0000000000006472. Epub 2018 Oct 12.
OBJECTIVE
To identify clinical and EEG biomarkers of drug resistance in adults with idiopathic generalized epilepsy.
METHODS
We conducted a case-control study consisting of a discovery cohort and a replication cohort independently assessed at 2 different centers. In each center, patients with the idiopathic generalized epilepsy phenotype and generalized spike-wave discharges on EEG were classified as drug-resistant or drug-responsive. EEG changes were classified into predefined patterns and compared between the 2 groups in the discovery cohort. Factors associated with drug resistance in multivariable analysis were tested in the replication cohort.
RESULTS
The discovery cohort included 85 patients (29% drug-resistant and 71% drug-responsive). Their median age at assessment was 32 years and 50.6% were female. Multivariable analysis showed that higher number of seizure types ever experienced (3 vs 1: odds ratio [OR] = 31.1, 95% confidence interval [CI]: 4.5-214, < 0.001; 3 vs 2: OR = 14.6, 95% CI: 2.3-93.1, = 0.004) and generalized polyspike train (burst of generalized rhythmic spikes lasting less than 1 second) during sleep were associated with drug resistance (OR = 10.8, 95% CI: 2.4-49.4, = 0.002). When these factors were tested in the replication cohort of 80 patients (27.5% drug-resistant and 72.5% drug-responsive; 71.3% female; median age 27.5 years), the proportion of patients with generalized polyspike train during sleep was also higher in the drug-resistant group (OR = 4.0, 95% CI: 1.35-11.8, = 0.012).
CONCLUSION
Generalized polyspike train during sleep may be an EEG biomarker for drug resistance in adults with idiopathic generalized epilepsy.
目的
确定特发性全面性癫痫成人患者中耐药的临床和 EEG 生物标志物。
方法
我们进行了一项病例对照研究，包括一个发现队列和一个在 2 个不同中心独立评估的复制队列。在每个中心，具有特发性全面性癫痫表型和 EEG 上广泛棘波放电的患者被分类为耐药或反应性。将 EEG 变化分类为预定义的模式，并在发现队列中比较两组之间的差异。在复制队列中测试多变量分析中与耐药相关的因素。
结果
发现队列包括 85 名患者（29%耐药，71%反应性）。他们评估时的中位年龄为 32 岁，50.6%为女性。多变量分析显示，既往经历的发作类型数量较多（3 种比 1 种：比值比 [OR] = 31.1，95%置信区间 [CI]：4.5-214， < 0.001；3 种比 2 种：OR = 14.6，95% CI：2.3-93.1， = 0.004）和睡眠期间的广泛多棘波串（持续不到 1 秒的广泛节律性棘波爆发）与耐药相关（OR = 10.8，95% CI：2.4-49.4， = 0.002）。当这些因素在 80 名患者的复制队列中进行测试时（27.5%耐药，72.5%反应性；71.3%女性；中位年龄 27.5 岁），睡眠期间存在广泛多棘波串的患者在耐药组中比例也更高（OR = 4.0，95% CI：1.35-11.8， = 0.012）。
结论
睡眠期间的广泛多棘波串可能是特发性全面性癫痫成人患者耐药的 EEG 生物标志物。
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