Nazish Saima, Shariff Erum, Zafar Azra, Aljaafari Danah, Alshamrani Foziah, Alkhaldi Norah A, Alsulaiman Feras, Shahid Rizwana, Albakr Aishah, Alsulaiman Abdullah, Alabdali Majed, Soltan Nehad, Alkhaldi Modhi
Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Ann Afr Med. 2024 Oct 1;23(4):688-696. doi: 10.4103/aam.aam_64_24. Epub 2024 Sep 14.
Activation procedures (APs) are adopted during routine electroencephalography (rEEG) to provoke interictal epileptiform abnormalities (EAs). This study aimed to observe interictal and ictal (EAs) of different EEG patterns, provoked by various APs.
This cross-sectional study was performed in the neurology department of King Fahd hospital of university, Saudi Arabia. The EEGs and medical records of patients who presented for EEG recordings were screened initially, then 146 EEGs provoked EAs due to utilization of APs, were included for analysis.
Among all EEGs with provoked EAs, Non-rapid eye movement sleep (NREM) provoked EAs in 93 (63.7%) patients with following patterns, focal spike wave discharges (FSWDs) 45 (P= 0.01), focal spike wave discharges with bilateral synchrony (FSWDBS) 27 (P=0.03) and generalized spike wave discharges (GSWDs) 46 (P=0.01). Intermittent photic stimulation (IPS) most significantly provoked FSWDs in 07 patient (P =0.01) and GSWDs in 30 patients (P=<0.001) 7 patients (P = 0.01) and GSWDs in 30 patients (P < 0.001). Hyperventilation (HV) was associated with a higher occurrence of GSWDs in 37 patients (P =0.01). Female sex 7 (P = 0.02), provoked GSWDs 3 (P = 0.03), NREM sleep 8 (P = 0.04), prolonged EEG record 3 (P = 0.02), clinical events during recording 5 (P ≤ 0.01), diagnosis of genetic 05 (P = 0.03), and immune-mediated epilepsies 2 (P = 0.001) were associated with the provocation of ictal EAs; however, in multiple logistic regression analysis, no statistically significant association of these variables (P ≥ 0.05 each) was noted.
The provocation of EAs in rEEG with different APs varies according to circumstances, including seizure types, epilepsy etiology, and the type of AP applied. These clinical and procedural parameters affect the diagnostic yield of rEEG and need careful consideration during rEEG recordings. APs adopted during rEEG recording can induce FSWDs, FSWDBS, and GSWDs in the form of either interictal or ictal EAs in various etiologies of epilepsy. Ictal EAs may appear in the form of GSWDs, during NREM sleep, in prolonged EEG records; however, their independent association needs to be evaluated in larger sample studies. Further, prospective cohort studies with adequate sample sizes are warranted.
在常规脑电图（rEEG）检查过程中采用激活程序（APs）来诱发发作间期癫痫样异常（EAs）。本研究旨在观察由各种APs诱发的不同脑电图模式的发作间期和发作期（EAs）情况。
本横断面研究在沙特阿拉伯法赫德国王大学医院神经内科进行。最初对前来进行脑电图记录的患者的脑电图和病历进行筛选，然后纳入146份因使用APs而诱发EAs的脑电图进行分析。
在所有诱发EAs的脑电图中，非快速眼动睡眠（NREM）在93例（63.7%）患者中诱发EAs，其模式如下：局灶性棘波放电（FSWDs）45例（P = 0.01），双侧同步局灶性棘波放电（FSWDBS）27例（P = 0.03），全身性棘波放电（GSWDs）46例（P = 0.01）。间歇性光刺激（IPS）最显著地在7例患者中诱发FSWDs（P = 0.01），在30例患者中诱发GSWDs（P =<0.001）。过度换气（HV）与37例患者中GSWDs的较高发生率相关（P = 0.01）。女性7例（P = 0.02）、诱发GSWDs 3例（P = 0.03）、NREM睡眠8例（P = 0.04）、脑电图记录延长3例（P = 0.02）、记录期间的临床事件5例（P ≤ 0.01）、遗传性诊断05例（P = 0.03）以及免疫介导性癫痫2例（P = 0.001）与发作期EAs的诱发相关；然而，在多因素逻辑回归分析中，未发现这些变量有统计学意义的关联（各P≥0.05）。
rEEG中不同APs诱发EAs的情况因多种因素而异，包括癫痫发作类型、癫痫病因以及所应用的AP类型。这些临床和操作参数会影响rEEG的诊断阳性率，在rEEG记录过程中需要仔细考虑。rEEG记录过程中采用的APs可在各种癫痫病因中以发作间期或发作期EAs的形式诱发FSWDs、FSWDBS和GSWDs。发作期EAs可能以GSWDs的形式出现在NREM睡眠期间以及延长的脑电图记录中；然而，它们的独立关联需要在更大样本研究中进行评估。此外，有必要进行样本量充足的前瞻性队列研究。
