The analysis of clinical characteristics and video EEG in adult patients with sleep related epilepsy in 187 cases_Journal of Epilepsy

Authors：

HUANG Sha ,  XIAO Bo , FENG Li , LONG Lili , LONG Hongyu , XIE Yuanyuan , ZHAO Haiting , GUO Danny , JIANG Haiyan , PENG Jinxin

Department of Neurology, Xiangya Hospital of Central South University, Changsha 410008, China;

Corresponding author：

XIAO Bo, Email: xiaobo_xy@126.com

Keywords：

Sleep epilepsy; Behavioristics; Video-EEG; Epileptiform discharge

DOI：

10.7507/2096-0247.20190003

Video：

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Objective To summarize and analyze the clinical and video-EEG (VEEG) characteristics of adult sleep-related epilepsy, so as to provide evidence for clinical diagnosis, differential diagnosis and treatment. Methods The clinical data, routine EEG and long-term VEEG of 187 adult patients with sleep-related epilepsy treated in Department of Neurology, Xiangya Hospital, Central South University from January 2017 to December 2017 were retrospectively analyzed by χ² test. Results Clinical manifestations: The duration of sleep-related epilepsy in 187 adults was concentrated in 1～10 years (101 cases, 54.01%); the frequency of seizures was mainly from several to dozens of times a year (99 cases, 52.94%); 119 cases (63.64%) had two or more types of seizures. Among the patients, 121 cases (39.29%) had focal origin, 152 cases (49.35%) had bilateral tonic clonus and 110 cases (58.82%) were treated with two or more drugs. EEG results: ① The detection rate of epileptiform discharges in routine EEG was 22.78%, and that in long-term video EEG was 80.43%. There was significant difference between the two methods (P< 0.01); ② Eighteen epileptiform discharges were monitored by routine EEG during interparoxysmal period and 111 epileptiform discharges were monitored by video EEG; and ③ Fifty-six epileptic events were monitored and all occurred in the process of long-term VEEG monitoring, 50 of them occurred in sleep (89.29%) and 6 in awake (10.71%); 45 cases (80.36%) were diagnosed as epileptic seizures, 9 cases (16.07%) were diagnosed as non-epileptic seizures, and 2 cases (3.57%) could not be determined. ④ The detection rate of epileptic discharges during sleep was higher than that during awake period in long-term VEEG monitoring (P< 0.01). The detection rate of epileptiform discharges in NREM stage I–II was the highest in sleep stage. Conclusion Sleep-related epilepsy in adults has certain clinical features and EEG manifestations. Compared with conventional EEG, long-term video-EEG can improve the detection rate of epileptiform discharges, provide diagnostic basis for the qualitative analysis of sleep-related seizures, and reflect the relationship between epileptiform discharges and sleep, and provide basis for the clinical diagnosis and treatment of sleep-related epilepsy in adults.

Citation： HUANG Sha, XIAO Bo, FENG Li, LONG Lili, LONG Hongyu, XIE Yuanyuan, ZHAO Haiting, GUO Danny, JIANG Haiyan, PENG Jinxin. The analysis of clinical characteristics and video EEG in adult patients with sleep related epilepsy in 187 cases. Journal of Epilepsy, 2019, 5(1): 16-20. doi: 10.7507/2096-0247.20190003 Copy

1.	Kirsten MF, Khara MS, Samuel W, et al. Prevalence and incidenceof epilepsy: A systematic review and meta-analysis of international studies. Neurology, 2017, 88(3): 296-303.
2.	蔡梦婷, 丁美萍. 癫痫患者对照料者和家庭及社会的影响研究. 癫痫杂志, 2018, 4(4): 330-333.
3.	Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology. Epilepsia, 2017, 58(4): 512-521.
4.	孙忠华. 睡眠相关性癫病: 2008年中国睡眠研究会第五届学术年会论文集. 昆明: 中国睡眠研究会, 2008: 245-250.
5.	Eriksson SH. Epilepsy and sleep. Curr Opin Neurol, 2011, 24(2): 171-176.
6.	Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic: a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115: 119-125.
7.	Rocamora R, Sánchez-Alvarez JC, Salas-Puig J. The relationship between sleep and epilepsy. Neurologist, 2008, 14(6 Suppl 1): 35-43.
8.	Bazil CW, Castro LH, Walczak TS. Reduction of rapid eye movement sleep by diurnal and nocturnal seizures in temporal lobe epilepsy. Arch Neurol, 2000, 57(3): 363-368.
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10.	黄莎, 肖波, 龙莉莉, 等. 长程视频脑电图在癫痫诊断与鉴别诊断中的作用. 中国现代神经疾病杂志, 2014, 11(14): 987-989.
11.	方赟, 葛剑青, 王凌玲, 等. 长程视频脑电图监测对睡眠相关性癫痫的诊断价值. 南京医科大学学报(自然科学版), 2016, 11(11): 1376-1378.
12.	Li P, Ghadersohi S, Jafari B, et al. Characteristics of refractory vs medically controlled epilepsy patients with obstructive sleep apnea and their response to CPAP treatment. Seizure, 2012, 21(9): 717-721.
13.	Kataria L, Vanghn BV. Sleep and epilepsy. Sleep Med Clin, 2016, 11(1): 25-38.
14.	Lucey BP, Noetzel MJ, Duntley SP. Paroxysmal arousals and myoclonic movements associated with interictal epileptiform discharges in NREM and REM sleep. Clin Neurol Neurosurg, 2011, 113(5): 419-422.
15.	Busek P, Buskova J, Nevsimalova S. Interictal epileptiform discharges and phasic phenomena of REM sleep. Epileptic Disord, 2010, 12(3): 217-221.
16.	James D, Geyer EE, Fetterman Z, et al. Epilepsy and restless legs syndrome. Epilepsy Behav, 2017, 68: 41-44.
17.	Jain SV, Horn PS, Simakajornboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1): 77-82.
18.	Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic: a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115: 119-125.
19.	Jain SV, Horn PS, SimakaJomboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1): 77.
20.	Chihorek AM, Abou-Khalil B, Malow BA. Obstructive sleep apneais associated with seizure occurrence in older adults with epilepsy. Neurology, 2007, 69(19): 1823-1827.
21.	Zhou JY, Tang XD, Huang LL, et a1. The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patientswith partial epilepsy. J Clin Neurosci, 2012, 19(7): 956-960.

1. Kirsten MF, Khara MS, Samuel W, et al. Prevalence and incidenceof epilepsy: A systematic review and meta-analysis of international studies. Neurology, 2017, 88(3): 296-303.
2. 蔡梦婷, 丁美萍. 癫痫患者对照料者和家庭及社会的影响研究. 癫痫杂志, 2018, 4(4): 330-333.
3. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology. Epilepsia, 2017, 58(4): 512-521.
4. 孙忠华. 睡眠相关性癫病: 2008年中国睡眠研究会第五届学术年会论文集. 昆明: 中国睡眠研究会, 2008: 245-250.
5. Eriksson SH. Epilepsy and sleep. Curr Opin Neurol, 2011, 24(2): 171-176.
6. Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic: a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115: 119-125.
7. Rocamora R, Sánchez-Alvarez JC, Salas-Puig J. The relationship between sleep and epilepsy. Neurologist, 2008, 14(6 Suppl 1): 35-43.
8. Bazil CW, Castro LH, Walczak TS. Reduction of rapid eye movement sleep by diurnal and nocturnal seizures in temporal lobe epilepsy. Arch Neurol, 2000, 57(3): 363-368.
9. UnterbergerI, Gabelia D, Prieschl M, et al. Sleep disorders and circadian rhythm in epilepsy revisited: a prospective controlled study. Sleep Med, 2015, 16(2): 237-242.
10. 黄莎, 肖波, 龙莉莉, 等. 长程视频脑电图在癫痫诊断与鉴别诊断中的作用. 中国现代神经疾病杂志, 2014, 11(14): 987-989.
11. 方赟, 葛剑青, 王凌玲, 等. 长程视频脑电图监测对睡眠相关性癫痫的诊断价值. 南京医科大学学报(自然科学版), 2016, 11(11): 1376-1378.
12. Li P, Ghadersohi S, Jafari B, et al. Characteristics of refractory vs medically controlled epilepsy patients with obstructive sleep apnea and their response to CPAP treatment. Seizure, 2012, 21(9): 717-721.
13. Kataria L, Vanghn BV. Sleep and epilepsy. Sleep Med Clin, 2016, 11(1): 25-38.
14. Lucey BP, Noetzel MJ, Duntley SP. Paroxysmal arousals and myoclonic movements associated with interictal epileptiform discharges in NREM and REM sleep. Clin Neurol Neurosurg, 2011, 113(5): 419-422.
15. Busek P, Buskova J, Nevsimalova S. Interictal epileptiform discharges and phasic phenomena of REM sleep. Epileptic Disord, 2010, 12(3): 217-221.
16. James D, Geyer EE, Fetterman Z, et al. Epilepsy and restless legs syndrome. Epilepsy Behav, 2017, 68: 41-44.
17. Jain SV, Horn PS, Simakajornboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1): 77-82.
18. Ismayilova VD, Ugur A, Tezer I. Subjective sleep disturbance in epilepsy patients at an outpatient clinic: a questionnaire-based study on prevalence. Epilepsy Res, 2015, 115: 119-125.
19. Jain SV, Horn PS, SimakaJomboon N, et al. Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol, 2013, 28(1): 77.
20. Chihorek AM, Abou-Khalil B, Malow BA. Obstructive sleep apneais associated with seizure occurrence in older adults with epilepsy. Neurology, 2007, 69(19): 1823-1827.
21. Zhou JY, Tang XD, Huang LL, et a1. The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patientswith partial epilepsy. J Clin Neurosci, 2012, 19(7): 956-960.

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