EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI

Yıl 2019, Cilt: 5 Sayı: 1, 18 - 31, 27.01.2019

Selen İlhan Alp Barış Baklan

Öz

Bu çalışmanın amacı, Dokuz Eylül Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı Epilepsi ve Uyku Merkezi Laboratuvarında 5 günlük video görüntüleme yapılan epileptik hasta nöbetlerinin gün içinde zamansal dağılımı ve uyku evreleriyle olan ilişkisi ile nöbet tiplerinin zamansal ilişkisini araştırılmasıdır. Bu çalışma; retrospektif, girişimsel olmayan, tanımlayıcı bir araştırma şeklinde yapılmıştır. 2005-2011 yılları arasında tetkik edilen, epilepsi tanısı almış ve 5 günlük video EEG görüntülemeleri yapılmış hastalar dahil edilmiştir. Hastaların yaş, cinsiyet, nöbet tipleri ve nöbetlerin ortaya çıkış saatleri, EEG patolojisi ile nöbet sayısı değişkenler olarak değerlendirildi. Hastaların nöbet tipleri; Parsiyel, sekonder jeneralize, primer jeneralize ve diyaleptik nöbet olarak sınıflandırılmıştır. EEG patolojisi; Temporal, frontal, jeneralize ve normal EEG kaydı şeklinde tanımlanmıştır.  Nöbetlerin zamansal dağılımı Grup 1: 00.00-5.59, Grup 2: 06.00-11.59, Grup 3: 12.00-17.59, Grup 4:18.00-23.59 olarak belirlendi. EEG patolojileri iktal ve interiktal döneme göre sınıflandırılmıştır. Çalışmaya Epilepsi ve Uyku Merkezi Laboratuvarında tetkik edilen 911 hasta arasından, epilepsi tanısı almış ve 5 günlük video görüntülemeleri yapılmış toplam 161 olgu alınmış, 113’ünde nöbet tespit edilmiş ve bunlar çalışmaya dahil edilmiştir. Bunların 60 (%53)’ı kadın, 53’ü (%47) erkek idi. Bu hastaların yaş ortalaması 28.56±11.7 yıl, izlenen toplam nöbet sayısı 497, ortalama nöbet süresi 84,6 (2-560) sn olarak hesaplandı. Nöbet tiplerinin %19.5’i primer jeneralize, %45.1’i parsiyel, %32.7’si sekonder jeneralize, %2.7’si diyaleptik nöbet olarak dağılım gösterdi.  Video EEG görüntüleme takiplerinde interiktal EEG kayıtlarında epileptik deşarjların lokalizasyonu incelendiğinde hastaların %50.4’sinde temporal, %15’inde frontal, %8’inde primer senkron epileptik aktivite izlenmiş olup kalan %26.5’da ise anormal potansiyel kayıtlanmadığı tespit edilmiştir. Video EEG görüntülemesi ile izlenen nöbetlerin uyku ile ilişkisi değerlendirildiğinde nöbet geçiren hastaların %24.8’inde uykuda, %19.5’inde uyanıklıkta, %55.7’inde hem uyku hem de uyanıklıkta nöbet tespit edilmiştir. Nöbet tiplerinden parsiyel ve sekonder jeneralize nöbetler uykuda daha fazla olarak ortaya çıkmaktadır ve bu oran istatistiksel olarak da anlamlı bulunmuştur (p<0.05). Video EEG kayıtlarında iktal EEG patolojisine göre nöbetlerin zamansal dağılımında temporal ve frontal epileptik aktivite izlenen hastalarda nöbetler 00.00-05.59 saatleri arasında istatistiksel olarak anlamlı bir artış göstermektedir. Çalışmamızda elde edilen veriler,  video görüntüleme ile 3 gün izlemin tanı için yeterli olabileceğini göstermektedir. Ayrıca nöbetlerin uyku dönemine bağlı bir dağılımı olduğu izlenmiştir. Temporal ve frontal lop nöbetler 00.00-05.59 saatleri arasında daha sık görülmektedir.  Uykunun epileptik nöbetleri tetiklediği ve uyku mikro yapısının nöbet eşiğini düşürdüğü anlaşılmaktadır. 

Anahtar Kelimeler

Epileptik nöbetler, uyku, sirkadiyen dağılım, EEG, video EEG görüntüleme, temporal lop epilepsi

CIRCADIAN DISTRIBUTION OF EPILEPTIC SEIZURES

Öz

In this study it was aimed to investigating the temporal distribution of the seizures of epileptic patients during the day and the relationship of their seizures with the stages of sleep by performing video monitorization for 5 days at Dokuz Eylül University School of Medicine, Department of Neurology Epilepsy and Sleep Center Laboratories. This study was conducted as a retrospective, non-interventional and descriptive research. Among patients who were investigated at Dokuz Eylül University School of Medicine, Department of Neurology Epilepsy and Sleep Center Laboratories from 2005 to 2011; 113 patients who were diagnosed as epilepsy and had 5 day video EEG images were selected and included in the study.  Age and sex of the patients, types of the seizures they experienced, the times at which these seizures happened and the numbers of seizures were evaluated as variables. The types of seizures of the patients were classified as: Partial, secondary, generalized, primary generalized and dialeptic. EEG pathologies were defined as: Temporal, frontal, generalized and normal EEG recordings.  Temporal distribution of the seizures were identified as: Group 1: 00.00-5.59, Group 2: 06.00-11.59, Group 3: 12.00-17.59, Group 4:18.00-23.59. EEG pathologies were classified according to ictal and interictal periods. Among 911 patients who were investigated at Epilepsy and Sleep Center Laboratories, 161 patients diagnosed as epilepsy and had 5 day video EEG images were selected, 113 of them were identified to have seizures and included in the study. There were 60 female (53 %) and 53 male (47 %) patients. Mean age of the patients was 28.56±11.7 years, total number of observed seizures was 497, mean duration of a seizure was calculated as 84.6 (2-560) seconds. As concerns the distribution of the types of seizures; 19.5 % were primer generalized, 45.1% were partial, 32.7% were secondary generalized and 2.7% were dialeptic. When the localization of epileptic discharges were examined on interictal EEG recordings during video EEG imaging follow-up, 50.4% of the patients had temporal, 15% had frontal and 8% had primary synchronized epileptic activity. The remaining 26.5% did not have any abnormal potential recorded. When the seizures monitored with video EEG imaging were evaluated in terms of their relationship with sleep; 24.8% happened while asleep, 19.5% while awake, 55.7% while both asleep and awake. Of the seizure types, partial and secondary generalized seizures happen more frequently during sleep and this ratio was found to be statistically significant (p<0.05). On video EEG recordings, in patients having temporal and frontal epileptic activity in the temporal distribution of the seizures based on ictal EEG pathology, the seizures showed a statistically significant increase from 00.00 to 05.59am.  Leaving temporal seizures aside, when generalized seizures were compared with other seizure types, they were more frequently observed from 06.00am to 11.59am.  When the relationship of seizure foci with sleep was investigated, 31% of the seizures stemming from frontal lobe, 25% of the seizures stemming from temporal lobe, and 7.7% of generalized seizures were experienced during sleep. 50% of the cases with normal EEG findings experienced their seizures during sleep as well. The data obtained from the study demonstrate that follow-up of three days with video imaging could be sufficient for diagnosis purposes. Furthermore, it is observed that the seizures had a distribution in relation with the stage of sleep. Temporal and frontal lobe seizures were more frequently seen from 00.00 to 05.59am. Sleep triggers the epileptic seizures and the microstructure of sleep decreases seizure threshold.

Anahtar Kelimeler

Epilepsy, Sleep, Circadian Distribution, Video EEG imaging

Kaynakça

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