快速眼动睡眠在局灶性癫痫患者致痫灶定位中的价值。

The value of rapid eye movement sleep in the localization of epileptogenic foci for patients with focal epilepsy.

机构信息

Shanxi Medical University, Taiyuan City, Shanxi Province, 030001, China.

The First Hospital of Shanxi Medical University, Taiyuan City, Shanxi Province, 030001, China.

出版信息

Seizure. 2020 Oct;81:192-197. doi: 10.1016/j.seizure.2020.06.009. Epub 2020 Jul 14.

DOI:10.1016/j.seizure.2020.06.009

PMID:32854037

Abstract

PURPOSE

Our aim was to investigate the value of rapid eye movement (REM) during prolonged scalp video-electroencephalography (VEEG) in the localization of epileptogenic foci for patients with focal epilepsy.

METHOD

We retrospectively studied a total of 59 patients with focal epilepsy and 31 of 59 received surgery. We assessed localization of interictal epileptiform discharges (IEDs) during REM, non-rapid eye movement sleep (NREM) and wakefulness to compare with the localization of ictal EEG, clinical semiology, magnetic resonance imaging (MRI) and positron emission tomography (PET) and stereo-electroencephalogram (SEEG). We graded postoperative follow-up outcome according to Engel criteria to further verify the accuracy of localization of epileptogenic foci in REM-IEDs. NREM-IEDs and Wakefulness-IEDs. Stepwise multiple logistic regression was carried out to assess for independent association of good prognosis with REM accurate localization, temporal lobe epilepsy and MRI accurate localization.

RESULTS

Clinical semiology was concordant to REM-IEDs in 40 patients (72.7 %), NREM-IEDs in 27 (49.1 %), and Wakefulness-IEDs in 25 (45.5 %). MRI lesion was concordant with REM-IEDs in 35 patients (81.4 %), Wakefulness-IEDs in 26 (60.5 %), and NREM-IEDs in 25 (58.1 %). PET localization was concordant with REM-IEDs in 20 patients (76.9 %), Wakefulness-IEDs and NREM-IEDs in 11 (42.3 %). SEEG localization was concordant with REM-IEDs in 15 patients (65.2 %), Wakefulness-IEDs in 10 (43.5 %), and NREM-IEDs in 8 (34.8 %). Thirty-one patients received surgery, and 30 (96.8 %) of them achieved good seizure control (Engel I-III). The surgical site was concordant with REM-IEDs in 23 (74.2 %), Wakefulness-IEDs and NREM-IEDs in 14 (45.2 %). In addition, the accuracy of REM-IEDs localization in temporal epilepsy (90 %) was higher than that extra-temporal epilepsy (45.5 %). REM accurate localization of epileptogenic foci was an independent factor contributing to good prognosis (P = 0.025, OR = 12.368).

CONCLUSIONS

Compared with NREM-IEDs and Wakefulness-IEDs, REM-IEDs had most value for localization of epileptogenic foci in patients with focal epilepsy. REM-IEDs- accurate localization of epileptogenic foci was an independent factor contributing to good prognosis for postsurgical patients with focal epilepsy.

摘要

目的

本研究旨在探讨在局灶性癫痫患者中，快速眼动 (REM) 睡眠期间延长头皮视频脑电图 (VEEG) 在致痫灶定位中的价值。

方法

我们回顾性研究了 59 例局灶性癫痫患者，其中 31 例接受了手术治疗。我们评估了 REM、非快速眼动睡眠 (NREM) 和觉醒期间的发作间期棘波 (IEDs) 定位，与发作期 EEG、临床症状学、磁共振成像 (MRI)、正电子发射断层扫描 (PET) 和立体脑电图 (SEEG) 定位进行比较。我们根据 Engel 标准对术后随访结果进行分级，以进一步验证 REM-IEDs、NREM-IEDs 和觉醒期 IEDs 对致痫灶定位的准确性。采用逐步多因素逻辑回归分析，评估 REM 准确定位、颞叶癫痫和 MRI 准确定位与良好预后的独立相关性。

结果

40 例 (72.7%) 患者的临床症状学与 REM-IEDs 一致，27 例 (49.1%) 与 NREM-IEDs 一致，25 例 (45.5%) 与觉醒期 IEDs 一致。35 例患者的 MRI 病变与 REM-IEDs 一致，26 例 (60.5%) 与觉醒期 IEDs 一致，25 例 (58.1%) 与 NREM-IEDs 一致。20 例患者的 PET 定位与 REM-IEDs 一致，11 例 (42.3%) 与觉醒期 IEDs 和 NREM-IEDs 一致。15 例患者的 SEEG 定位与 REM-IEDs 一致，10 例 (43.5%) 与觉醒期 IEDs 一致，8 例 (34.8%) 与 NREM-IEDs 一致。31 例患者接受了手术治疗，其中 30 例 (96.8%) 达到了良好的癫痫控制 (Engel I-III)。23 例 (74.2%) 的手术部位与 REM-IEDs 一致，14 例 (45.2%) 与觉醒期 IEDs 和 NREM-IEDs 一致。此外，颞叶癫痫的 REM-IEDs 定位准确性 (90%) 高于非颞叶癫痫 (45.5%)。REM 致痫灶的准确定位是术后患者预后良好的独立因素 (P=0.025，OR=12.368)。