Serlin Yonatan, Imtiaz Hamza, Avigdor Tamir, Minarik Anna, Lash Sina, Bardouille Timothy, Whatley Ben, Ikeda Kristin M, Milikovsky Dan Z, Inati Sara K, Rüber Theodor, Surges Rainer, Rácz Attila, Friedman Alon
Neurophysiology of Epilepsy Unit, NINDS, National Institutes of Health, Bethesda, MD, USA; Department of Medical Neuroscience and the Brain Repair Center, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada.
Department of Medical Neuroscience and the Brain Repair Center, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada.
EBioMedicine. 2025 Jun;116:105780. doi: 10.1016/j.ebiom.2025.105780. Epub 2025 May 28.
Paroxysmal slow wave events (PSWEs), defined as electroencephalography (EEG) segments where the median power frequency falls below 6 Hz for ≥5 s, have been shown to predict epilepsy in patients with a first seizure. We evaluated the prevalence and localisation of PSWEs in large independent EEG datasets, exploring their potential as biomarkers for drug-resistant epilepsy (DRE).
An exploratory analysis used 1064 participants from the Temple University EEG corpus, comparing patients with epilepsy (N = 903) with participants with seizure-mimics and normal EEGs (N = 161). Validation analysis used an independent cohort from Bonn University, comprising drug-responsive (N = 51) and patients with DRE (N = 44).
In the exploratory analysis, the proportion of time PSWEs were detected was longer in epilepsy compared with participants without epilepsy (P < 0.0001). Analyses of aetiology and EEG localisation revealed that PSWEs were most prolonged in patients with reported focal epilepsy (P = 0.004), particularly with temporal lobe involvement (P = 0.005). Patients with DRE had prolonged time in PSWEs (P = 0.005), corresponding with an increased risk of refractoriness (OR = 1.9; 95% CI 1.2-2.9). Validation analysis confirmed these findings, with prolonged PSWEs in DRE vs. drug-responsive patients (P < 0.0001, AUC = 0.829). Based on the cutoff established in the exploratory cohort, prolonged time in PSWEs in the validation cohort was associated with increased DRE risk (OR = 5.14, 95% CI 2.1-12.3). In patients with poor surgical outcomes (Engel IB-IV, N = 13), pre-surgical EEGs showed prolonged time in PSWEs compared with Engel IA (N = 24, P = 0.038).
Analysis of 1159 EEGs from two independent cohorts demonstrated that PSWEs are more prevalent and prolonged in patients with focal epilepsy and may indicate a lack of therapeutic response.
The Canadian Institutes of Health Research (168164, 180636).
阵发性慢波事件（PSWEs）被定义为脑电图（EEG）中平均功率频率低于6 Hz持续≥5秒的片段，已被证明可预测首次发作患者的癫痫。我们评估了大型独立EEG数据集中PSWEs的患病率和定位，探讨其作为耐药性癫痫（DRE）生物标志物的潜力。
一项探索性分析使用了来自天普大学EEG语料库的1064名参与者，将癫痫患者（N = 903）与有癫痫样发作且EEG正常的参与者（N = 161）进行比较。验证分析使用了来自波恩大学的一个独立队列，包括药物反应性患者（N = 51）和DRE患者（N = 44）。
在探索性分析中，与无癫痫的参与者相比，癫痫患者中检测到PSWEs的时间比例更长（P < 0.0001）。病因学和EEG定位分析显示，报告为局灶性癫痫的患者PSWEs持续时间最长（P = 0.004），尤其是累及颞叶的患者（P = 0.005）。DRE患者的PSWEs持续时间延长（P = 0.005），与难治性风险增加相关（OR = 1.9；95%CI 1.2 - 2.9）。验证分析证实了这些发现，DRE患者与药物反应性患者相比PSWEs持续时间延长（P < 0.0001，AUC = 0.829）。根据探索性队列中确定的临界值，验证队列中PSWEs持续时间延长与DRE风险增加相关（OR = 5.14，95%CI 2.1 - 12.3）。手术效果不佳的患者（Engel IB - IV，N = 13）术前EEG显示PSWEs持续时间比Engel IA患者（N = 24，P = 0.038）更长。
对来自两个独立队列的1159份EEG进行分析表明，PSWEs在局灶性癫痫患者中更普遍且持续时间更长，可能表明缺乏治疗反应。
加拿大卫生研究院（168164, 180636）。
