Dave Hina, McCreary Morgan, Guerra Antonio, Sperling Michael R
Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Epilepsia. 2025 Jun;66(6):2089-2098. doi: 10.1111/epi.18331. Epub 2025 Feb 28.
OBJECTIVE: To shorten inpatient epilepsy monitoring unit (EMU) stays during epilepsy surgery evaluation, physicians utilize techniques to induce seizures including antiseizure medication (ASM) reduction, sleep deprivation, and chemical stimulation. We assessed the relative efficacy of these techniques. METHODS: We reviewed data from patients admitted for intracranial video-EEG (electroencephalography) evaluation at a single center. Demographics, baseline seizure frequency, seizure type, sleep deprivation, reduction in ASM, chemical stimulation method, and seizures were recorded. Statistical analyses were performed in R with survival analyses. RESULTS: A total of 209 patients were evaluated. We observed an increase in the risk of seizure occurrence of 1% for every increase of one seizure per week of baseline seizure frequency (confidence interval [CI] = 1.00-1.02, p = .009). Complete cessation of both sodium channel and non-sodium channel ASMs increase the rate of seizure occurrence (CI = 1.46-2.08, p < .0001 and CI = 1.28-1.80, p < .0001, respectively). A partial reduction in sodium channel drugs within 24 h of admission or previous seizure in the EMU increased seizure risk by 40% (CI = 1.18-1.72, p = .0002). For each seizure occurring during admission, the risk of seizure recurrence increased by 5% (CI = 1.03-1.08, p < .0001). Patients with temporal lobe epilepsy exhibited a 19% lower risk of seizures within the initial 24 h of admission than patients with extratemporal seizures (CI = .68-.97, p = .02). Neither chemical stimulation nor sleep deprivation impacted seizure risk. SIGNIFICANCE: We found that ASM reduction was the only method that effectively induced seizures in hospitalized patients; sleep deprivation and chemical induction failed to do so. Prospective studies are needed to further understand these induction methods.
目的:在癫痫手术评估期间,为缩短住院患者在癫痫监测单元(EMU)的停留时间,医生采用包括减少抗癫痫药物(ASM)、睡眠剥夺和化学刺激等技术来诱发癫痫发作。我们评估了这些技术的相对疗效。 方法:我们回顾了在单一中心接受颅内视频脑电图(EEG)评估的患者数据。记录了人口统计学信息、基线癫痫发作频率、发作类型、睡眠剥夺、ASM减少情况、化学刺激方法和癫痫发作情况。在R软件中进行统计分析并采用生存分析。 结果:共评估了209例患者。我们观察到,基线癫痫发作频率每增加每周一次癫痫发作,癫痫发作风险增加1%(置信区间[CI]=1.00 - 1.02,p = 0.009)。完全停用钠通道和非钠通道ASM均会增加癫痫发作率(CI分别为1.46 - 2.08,p < 0.0001和CI为1.28 - 1.80,p < 0.0001)。入院24小时内或在EMU中上次癫痫发作后24小时内部分减少钠通道药物会使癫痫发作风险增加40%(CI = 1.18 - 1.72,p = 0.0002)。对于入院期间发生的每一次癫痫发作,癫痫复发风险增加5%(CI = 1.03 - 1.08,p < 0.0001)。颞叶癫痫患者在入院最初24小时内癫痫发作风险比颞叶外癫痫患者低19%(CI = 0.68 - 0.97,p = 0.02)。化学刺激和睡眠剥夺均未影响癫痫发作风险。 意义:我们发现减少ASM是在住院患者中有效诱发癫痫发作的唯一方法;睡眠剥夺和化学诱导未能做到这一点。需要进行前瞻性研究以进一步了解这些诱导方法。
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