Zhang Han, Yan Lisi, Peng Xiaoling, Jiang Li, Zhang Junjiao, Chen Jin, Hu Yue
Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Epileptic Disord. 2023 Oct;25(5):690-701. doi: 10.1002/epd2.20095. Epub 2023 Jul 14.
To simplify the electroencephalogram (EEG) diagnosis and guide the treatment of electrical status epilepticus during sleep (ESES).
We recruited 54 children with ESES from December 2019 to December 2020 and compared various spike-wave index (SWI) calculation methods. Time-frequency analysis assessed the correlation between high-frequency oscillations energy and the SWI. We divided 42 children into responder and non-responder treatment groups based on the observations made during a 12-month follow-up period and evaluate different treatment and the independent risk factors of refractory ESES.
The SWI of 5 min before the second sleep cycle of non-rapid eye movement (NREM; long method II) and that of all NREM sleep (total method) were not significantly different (p = .06). The average energy of γ (r = .288, p = .002) and ripple (r = .203, p = .04) oscillations were correlated with the SWI. Multivariable logistic regression analysis showed that encephalomalacia was an independent risk factor for refractory ESES (OR: 10.48, 95% CI: 1.62-67.63). The clinical seizure improvement rates of anti-seizure medications (ASMs), ASMs with benzodiazepines, and ASMs with benzodiazepines and steroids after 12 months were 9.3%, 42.8%, and 53.8%, EEG improvement rate were 5.5%, 30.9% and 37%, respectively. The intelligence of the children in the responder treatment group has improved during the 1-year follow-up.
These findings demonstrate EEG and clinical features of ESES and may provide basis for simplifying diagnosis and guiding the treatment of children with ESES.
简化脑电图（EEG）诊断并指导睡眠期癫痫性电持续状态（ESES）的治疗。
我们在2019年12月至2020年12月招募了54例ESES患儿，比较了各种棘慢波指数（SWI）计算方法。时频分析评估高频振荡能量与SWI之间的相关性。根据12个月随访期间的观察结果，将42例患儿分为治疗反应组和无反应组，并评估不同治疗方法及难治性ESES的独立危险因素。
非快速眼动（NREM）第二个睡眠周期前5分钟的SWI（长方法II）与所有NREM睡眠的SWI（总方法）无显著差异（p = 0.06）。γ波（r = 0.288，p = 0.002）和涟漪波（r = 0.203，p = 0.04）振荡的平均能量与SWI相关。多变量逻辑回归分析显示，脑软化是难治性ESES的独立危险因素（OR：10.48，95%CI：1.62 - 67.63）。12个月后，抗癫痫药物（ASM）、ASM联合苯二氮䓬类药物、ASM联合苯二氮䓬类药物和类固醇治疗的临床癫痫改善率分别为9.3%、42.8%和53.8%，EEG改善率分别为5.5%、30.9%和37%。治疗反应组患儿在1年随访期间智力有所改善。
这些发现展示了ESES的EEG和临床特征，可能为简化儿童ESES的诊断和指导治疗提供依据。
