快速眼动睡眠对颞叶内侧和新皮层区域的癫痫发作间期活动的影响不同。

Rapid eye movement sleep affects interictal epileptic activity differently in mesiotemporal and neocortical areas.

机构信息

Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.

Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.

出版信息

Epilepsia. 2023 Nov;64(11):3036-3048. doi: 10.1111/epi.17763. Epub 2023 Sep 30.

DOI:10.1111/epi.17763

PMID:37714213

Abstract

OBJECTIVE

Rapid eye movement (REM) sleep reduces the rate and extent of interictal epileptiform discharges (IEDs). Breakthrough epileptic activity during REM sleep is therefore thought to best localize the seizure onset zone (SOZ). We utilized polysomnography combined with direct cortical recordings to investigate the influences of anatomical locations and the time of night on the suppressive effect of REM sleep on IEDs.

METHODS

Forty consecutive patients with drug-resistant focal epilepsy underwent combined polysomnography and stereo-electroencephalography during presurgical evaluation. Ten-minute interictal epochs were selected 2 h prior to sleep onset (wakefulness), and from the first and second half of the night during non-REM (NREM) sleep and REM sleep. IEDs were detected automatically across all channels. Anatomic localization, time of night, and channel type (within or outside the SOZ) were tested as modulating factors.

RESULTS

Relative to wakefulness, there was a suppression of IEDs by REM sleep in neocortical regions (median = -27.6%), whereas mesiotemporal regions showed an increase in IEDs (19.1%, p = .01, d = .39). This effect was reversed when comparing the regional suppression of IEDs by REM sleep relative to NREM sleep (-35.1% in neocortical, -58.7% in mesiotemporal, p < .001, d = .39). Across all patients, no clinically relevant novel IED regions were observed in REM sleep versus NREM or wakefulness based on our predetermined thresholds (4 IEDs/min in REM, 0 IEDs/min in NREM and wakefulness). Finally, there was a reduction in IEDs in late (NREM: 1.08/min, REM: .61/min) compared to early sleep (NREM: 1.22/min, REM: .69/min) for both NREM (p < .001, d = .21) and REM (p = .04, d = .14).

SIGNIFICANCE

Our results demonstrate a spatiotemporal effect of IED suppression by REM sleep relative to wakefulness in neocortical but not mesiotemporal regions, and in late versus early sleep. This suggests the importance of considering sleep stage interactions and the potential influences of anatomical locations when using IEDs to define the epileptic focus.

摘要

目的

快速眼动（REM）睡眠可降低发作间期癫痫样放电（IED）的频率和幅度。因此，人们认为 REM 睡眠期间出现的突破性癫痫活动最能定位癫痫起始区（SOZ）。我们利用多导睡眠图结合皮质直接记录来研究解剖位置和夜间时间对 REM 睡眠抑制 IED 的影响。

方法

40 例药物难治性局灶性癫痫患者在术前评估期间接受了多导睡眠图和立体脑电图检查。在睡眠开始前 2 小时（清醒期）和非快速眼动（NREM）睡眠及 REM 睡眠的前半段和后半段，选择 10 分钟的发作间期期。在所有通道上自动检测 IED。解剖定位、夜间时间和通道类型（SOZ 内或 SOZ 外）作为调节因素进行测试。

结果

与清醒期相比，REM 睡眠使新皮质区域的 IED 减少（中位数=-27.6%），而中颞叶区域的 IED 增加（19.1%，p=0.01，d=0.39）。当比较 REM 睡眠相对于 NREM 睡眠对 IED 的区域抑制作用时，这种影响是相反的（新皮质为-35.1%，中颞叶为-58.7%，p<0.001，d=0.39）。在所有患者中，根据我们预设的阈值（REM 中每分 4 个 IED，NREM 和清醒期中每分 0 个 IED），与 NREM 或清醒期相比，在 REM 睡眠中未观察到具有临床意义的新 IED 区域。最后，NREM 期（NREM：1.08/min，REM：0.61/min）与早期睡眠相比（NREM：1.22/min，REM：0.69/min）IED 减少（NREM：p<0.001，d=0.21；REM：p=0.04，d=0.14）。