Shinnar S, Berg A T, Ptachewich Y, Alemany M
Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467.
Neurology. 1993 Apr;43(4):701-6. doi: 10.1212/wnl.43.4.701.
In a prospective study, we have followed 347 children identified at the time of a first unprovoked seizure for a mean of 46 months. To date, 135 (39%) have experienced a seizure recurrence. In this study, we analyzed recurrence risk as a function of whether the child was asleep or awake at the time of the first seizure. The cumulative recurrence risks for children whose first seizure occurred in sleep was 28% at 0.5 years, 39% at 1 year, 53% at 2 years, and 55% at 4 years, compared with recurrence risks of 18%, 23%, 30%, and 35% at the same intervals in children whose first seizure occurred while awake (p < 0.001). The association of a first seizure during sleep with an increased recurrence risk was present primarily in children with idiopathic seizures. It occurred in both those with a normal and an abnormal EEG. On multivariable analysis, sleep state, etiology, and the EEG were statistically significant predictors of recurrence risk. In children who experienced a seizure recurrence, the recurrences occurred in the same sleep state in 73% of the cases (p < 0.0001). This was also true of subsequent recurrences. We conclude that the occurrence of a first seizure in sleep is associated with an increased risk of recurrence. Subsequent seizures, if they do occur, usually occur in the same sleep state as the initial seizure.
在一项前瞻性研究中，我们对347名首次无诱因癫痫发作的儿童进行了平均46个月的随访。截至目前，135名（39%）儿童出现了癫痫复发。在本研究中，我们分析了癫痫复发风险与首次癫痫发作时儿童是 asleep（睡着）还是 awake（醒着）的关系。首次癫痫发作发生在睡眠中的儿童，其0.5岁时的累积复发风险为28%，1岁时为39%，2岁时为53%，4岁时为55%；而首次癫痫发作发生在清醒时的儿童，在相同时间间隔的复发风险分别为18%、23%、30%和35%（p<0.001）。睡眠中首次癫痫发作与复发风险增加之间的关联主要存在于特发性癫痫儿童中。在脑电图正常和异常的儿童中均有发生。多变量分析显示，睡眠状态、病因和脑电图是复发风险的统计学显著预测因素。在经历癫痫复发的儿童中，73%的病例复发发生在相同的睡眠状态（p<0.0001）。后续复发情况也是如此。我们得出结论，睡眠中首次癫痫发作与复发风险增加有关。如果确实发生后续癫痫发作，通常会发生在与首次癫痫发作相同的睡眠状态。
