From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA.
Neurology. 2023 Dec 4;101(23):e2376-e2387. doi: 10.1212/WNL.0000000000207942.
To investigate the spatiotemporal characteristics of sleep waveforms in temporal lobe epilepsy (TLE) and examine their association with cognition.
In this retrospective, cross-sectional study, we examined overnight EEG data from adult patients with TLE and nonepilepsy comparisons (NECs) admitted to the epilepsy monitoring unit at Mass General Brigham hospitals. Automated algorithms were used to characterize sleep macroarchitecture (sleep stages) and microarchitecture (spindles, slow oscillations [SOs]) on scalp EEG and to detect hippocampal interictal epileptiform discharges (hIEDs) from foramen ovale electrodes simultaneously recorded in a subset of patients with TLE. We examined the association of sleep features and hIEDs with memory and executive function from clinical neuropsychological evaluations.
A total of 81 adult patients with TLE and 28 NEC adult patients were included with similar mean ages. There were no significant differences in sleep macroarchitecture between groups, including relative time spent in each sleep stage, sleep efficiency, and sleep fragmentation. By contrast, the spatiotemporal characteristics of sleep microarchitecture were altered in TLE compared with NEC and were associated with cognitive impairments. Specifically, we observed a ∼30% reduction in spindle density in patients with TLE compared with NEC, which was significantly associated with worse memory performance. Spindle-SO coupling strength was also reduced in TLE and, in contrast to spindles, was associated with diminished executive function. We found no significant association between sleep macroarchitectural and microarchitectural parameters and hIEDs.
There is a fundamental alteration of sleep microarchitecture in TLE, characterized by a reduction in spindle density and spindle-SO coupling, and these changes may contribute to neurocognitive comorbidity in this disorder.
研究颞叶癫痫（TLE）睡眠波形的时空特征，并探讨其与认知的关系。
在这项回顾性、横断面研究中，我们检查了来自麻省总医院癫痫监测单元住院的成年 TLE 患者和非癫痫对照组（NEC）的整夜 EEG 数据。自动算法用于描述头皮 EEG 的睡眠宏观结构（睡眠阶段）和微观结构（纺锤波、慢波[SOs]），并在 TLE 患者亚组中同时记录卵圆孔电极的海马间发性癫痫样放电（hIED）。我们检查了睡眠特征和 hIED 与临床神经心理学评估中记忆和执行功能的关系。
共纳入 81 例成年 TLE 患者和 28 例 NEC 成年患者，平均年龄相似。两组间的睡眠宏观结构无显著差异，包括各睡眠阶段的相对时间、睡眠效率和睡眠片段化。相比之下，TLE 患者的睡眠微观结构的时空特征与 NEC 相比发生了改变，并且与认知障碍有关。具体来说，我们观察到 TLE 患者的纺锤波密度比 NEC 患者降低了约 30%，这与记忆表现更差显著相关。纺锤波-SO 耦合强度在 TLE 中也降低了，与纺锤波相反，与执行功能下降有关。我们没有发现睡眠宏观和微观结构参数与 hIED 之间有显著关联。
TLE 存在睡眠微观结构的根本改变，表现为纺锤波密度和纺锤波-SO 耦合的减少，这些变化可能导致该疾病的神经认知共病。
