Han Yixian, Gao Jing, Zhou Yongkang, Deng Jiahui, Yang Huajun, Wang Xiongfei, Wang Jing, Yang Yujiao, Ren Jie, Chen Lingling, Wang Minghui, Deng Qinqin, Wang Haidan, Wang Mengyang, Li Tianfu
Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
CNS Neurosci Ther. 2025 Jul;31(7):e70501. doi: 10.1111/cns.70501.
BACKGROUND: Patients with self-limited epilepsy with centrotemporal spikes (SeLECTS) and electrical status epilepticus in sleep (ESES) lead to cognitive impairment. However, therapeutic options are limited. OBJECTIVES: The sleep spindle is a biomarker of cognitive dysfunction in patients with SeLECTS. This study aimed to explore whether the sleep spindle is linked to the outcome of repetitive transcranial magnetic stimulation (rTMS) in patients with SeLECTS with ESES. METHODS: Nine patients with SeLECTS with ESES underwent low-frequency rTMS (≤ 1 Hz) or continuous theta burst stimulation (cTBS) for 10 days. To assess the clinical efficacy and alteration in the sleep spindle, EEG recordings were performed both before and after rTMS. A machine learning algorithm YASA was used to calculate the coupling of the sleep spindle and slow waves. RESULTS: 75% of patients remained seizure-free for 6 months after rTMS. The spike-wave index (SWI) decreased significantly after rTMS compared with the baseline. The sleep spindle significantly increased in all patients at 3 months and 6 months after rTMS (p = 0.002). Both IQ and MQ improved significantly at 6 months after rTMS. Improvement of IQ and increase of the sleep spindle was significantly positively correlated (p = 0.035). The mean probability of the sleep spindle coupling in the slow wave "up" state increased from 28% to 55%. CONCLUSION(S): Increase of the sleep spindle and the mean probability of the sleep spindle coupling in the slow wave "up" state might be a potential mechanism for cognition improvement in patients with SeLECTS with ESES.
背景：伴有中央颞区棘波的自限性癫痫（SeLECTS）和睡眠中癫痫性电持续状态（ESES）患者会导致认知障碍。然而，治疗选择有限。 目的：睡眠纺锤波是SeLECTS患者认知功能障碍的生物标志物。本研究旨在探讨睡眠纺锤波是否与伴有ESES的SeLECTS患者重复经颅磁刺激（rTMS）的疗效相关。 方法：9例伴有ESES的SeLECTS患者接受了为期10天的低频rTMS（≤1Hz）或连续theta爆发刺激（cTBS）。为评估临床疗效和睡眠纺锤波的变化，在rTMS前后均进行了脑电图记录。使用机器学习算法YASA计算睡眠纺锤波与慢波的耦合。 结果：75%的患者在rTMS后6个月无癫痫发作。与基线相比，rTMS后棘波指数（SWI）显著降低。rTMS后3个月和6个月时，所有患者的睡眠纺锤波均显著增加（p = 0.002）。rTMS后6个月时，智商（IQ）和记忆商（MQ）均显著改善。IQ的改善与睡眠纺锤波的增加显著正相关（p = 0.035）。睡眠纺锤波在慢波“上升”状态下耦合的平均概率从28%增加到55%。 结论：睡眠纺锤波的增加以及睡眠纺锤波在慢波“上升”状态下耦合的平均概率可能是伴有ESES的SeLECTS患者认知改善的潜在机制。
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