Year 2019, Volume 5 , Issue 1, Pages 18 - 31 2019-01-27

CIRCADIAN DISTRIBUTION OF EPILEPTIC SEIZURES
EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI

Selen İLHAN ALP [1] , Barış BAKLAN [2]


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.


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. 

  • 1. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30(4): 389-399.
  • 2. Temkin, O. The falling Sickness: A History of epilepsy from the Greeks to the Beginnings of Modern Neurology. Johns Hopkins pres, Baltimore, MD 1994
  • 3. Mendez M, Radtke RA. Interactions between sleep and epilepsy. J Clin Neurophysiol 2001;18:106-27.
  • 4. Ferrillo F, Beelke M, Nobili L. Sleep EEG synchronization mechanisms and activation of interictal epileptic spikes. 2000;111(2):65-73.
  • 5. Bazil, C.W.,Walczak,T.S. Effects of sleep and sleep stage on epileptic and nonepileptic seizures. Epilepsia 1997;38: 56-62
  • 6. Matos G, Andersen ML, do Valle AC, Tufik S. The relationship between sleep and epilepsy: evidence from clinical trials and animal models. J Neurol Sci. 2010;295:1–7.
  • 7. Lamont EW, James FO, Boivin DB, Cermakian N. From circadian clock gene expression to pathologies. Sleep Med 2007;8(6):547–56.
  • 8. Parrino L, Spaggiari MC, Boselli M, Barusi R, Terzano MG. Effects of prolonged wakefulness on cyclic alternating pattern (CAP) during sleep recovery at different circadian phases. J Sleep Res 1993;2:91-5.
  • 9. Avanzini G, Panzica F, de Curtis M. The role of the thalamus in vigilance and epileptogenic mechanisms. Clin Neurophysiol. 2000;111 (Suppl 2):19-26.
  • 10. Pavlova MK, Shea SA, Bromfield EB. Day/night patterns of focal seizures. Epilepsy Behav. 2004;5:44–49.
  • 11. Billiard, M.,Besset,A.,Zachariev, Z et all. Relation of seizures and seizure discharges to sleep stages. In:P. Wolf, M. Dam, D. Janz, F.E. Dreifuss (Eds.), Advances in Epileptology, Volume 16. Raven Pres, New York, 1987; 665-670.
  • 12. Shoue MN, Scordato JC, Farber PR. Sleep and arousal mechanisms in experimental epilepsy: epileptic components of NREM and antiepileptic components in REM sleep. Ment Retard Dec Disabil Res Rev 2004; 10: 117-121.
  • 13. Zucconi, M., Oldani,A., Ferini-Strambi, L. Et all Nocturnal paroxysmal arousals with motor behaviors during sleep:frontal lobe epilepsy or parasomnia? J.Clin. Neurophysiol. 1997;14:513-522.
  • 14. Crespel, A.,Baldy-Moulnier, M.,Cobes, P. The relationship between sleep and epilepsy in frontal and temporal lobe epilepsies: practical and physiopathologic considerations, Epilepsia 1998;39:150-157.
  • 15. Hofstra WA, Gordijn MC, van Hemert-van der Poel JC, et al. Chronotypes and subjective sleep parameters in epilepsy patients: a large questionnaire study. Chronobiol Int. 2010;27: 1271–1286.
  • 16. Bazil, C.W., Castro, L.H.M., Walczak, T.S. Diurnal and nocturnal seizures reduce REM sleep in patients with temporale lobe epilepsy. Arch. Neurol. 57, 2000;363-368.
  • 17. Weerd, A., Haas, S., Otte, A., et all Subjective sleep disturbance in patients with partial epilepsy:A questionnaiere-based study on prevalance and impact on quality of life Epilepsia, 2004,45(11):1397-1404.
  • 18. Loddenkemper T, Lockley SW., Kaleyias J, K. Sanjeev V. Chronobiology of epilepsy: Diagnostic and therapeutic implications of chrono-epileptology. J Clin Neurophysiol 2011;28: 146–153.
  • 19. Kotagal P, Yardi N. The relationship between sleep and epilepsy. Semin Pediatr Neurol. 2008;15: 42– 49.
  • 20. Baklan B. Uyku ve epilepsi. Turkiye Klinikleri J Neurol-Special Topics 2008;1(2):56-64.
  • 21. Durazzo T.S., Spencer S.S., Duckrow R.B., Novotny, E.J. et all. Temporal distributions of seizure occurrence from various epileptogenic regions. Neurology. 2008;70: 1265–1271.
  • 22. R. Mai, I. Sartori , S. Francione, L. Tassi et al. Sleep-related hyperkinetic seizures: Always a frontal onset? Neurol Sci 2005; 26:220-4.
  • 23. Bradley V. Vaughn and O’Neill F. D’Cruz. Epilepsy and Sleep. In Sleep Disorders and Neurologic Diseases, Ed. Culebras A, İnforma, New York 2007; 229-254.
  • 24. Bjorvatn B, Pallesen S. A practical approach to circadian rhythm sleep disorders. Sleep Med Rev 2009;13:47–60.
  • 25. Gigli GL, Valente M. Sleep and EEG interictal epileptiform abnormalities in partial epilepsy. J Clin Neurophysiol 2000;111 (suppl 2):60-4.
  • 26. Ekizoglu E, Baykan B, Bebek N. et al. Sleep characteristics of patients with pure sleep-related seizures. Epilepsy Behav 2011;21:71-5.
  • 27. Hofstra A.W. Grootemarsink E.B, Dieker R, Palen J, and Weerd A W. Temporal distribution of clinical seizures over the 24-h day: A retrospective observational study in a tertiary epilepsy clinic. Epilepsia, 2009; 50(9):2019–2026.
Primary Language tr
Subjects Health Care Sciences and Services
Journal Section Research Article
Authors

Author: Selen İLHAN ALP (Primary Author)
Institution: Namık Kemal Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu
Country: Turkey


Author: Barış BAKLAN
Institution: DOKUZ EYLÜL ÜNİVERSİTESİ
Country: Turkey


Dates

Publication Date : January 27, 2019

Bibtex @research article { iaaojh505181, journal = {International Anatolia Academic Online Journal Health Sciences}, issn = {}, eissn = {2148-3159}, address = {Hürriyet Mahallesi Dolu Sokak Elam KOnakları A Blok Daire 15 Süleymanpaşa Tekirdağ}, publisher = {Abdülkadir IŞIK}, year = {2019}, volume = {5}, pages = {18 - 31}, doi = {}, title = {EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI}, key = {cite}, author = {İLHAN ALP, Selen and BAKLAN, Barış} }
APA İLHAN ALP, S , BAKLAN, B . (2019). EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI. International Anatolia Academic Online Journal Health Sciences , 5 (1) , 18-31 . Retrieved from https://dergipark.org.tr/en/pub/iaaojh/issue/41030/505181
MLA İLHAN ALP, S , BAKLAN, B . "EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI". International Anatolia Academic Online Journal Health Sciences 5 (2019 ): 18-31 <https://dergipark.org.tr/en/pub/iaaojh/issue/41030/505181>
Chicago İLHAN ALP, S , BAKLAN, B . "EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI". International Anatolia Academic Online Journal Health Sciences 5 (2019 ): 18-31
RIS TY - JOUR T1 - EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI AU - Selen İLHAN ALP , Barış BAKLAN Y1 - 2019 PY - 2019 N1 - DO - T2 - International Anatolia Academic Online Journal Health Sciences JF - Journal JO - JOR SP - 18 EP - 31 VL - 5 IS - 1 SN - -2148-3159 M3 - UR - Y2 - 2019 ER -
EndNote %0 International Anatolia Academic Online Journal Health Sciences EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI %A Selen İLHAN ALP , Barış BAKLAN %T EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI %D 2019 %J International Anatolia Academic Online Journal Health Sciences %P -2148-3159 %V 5 %N 1 %R %U
ISNAD İLHAN ALP, Selen , BAKLAN, Barış . "EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI". International Anatolia Academic Online Journal Health Sciences 5 / 1 (January 2019): 18-31 .
AMA İLHAN ALP S , BAKLAN B . EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI. IAAOJH. 2019; 5(1): 18-31.
Vancouver İLHAN ALP S , BAKLAN B . EPİLEPTİK NÖBETLERİN SİRKADYEN DAĞILIMI. International Anatolia Academic Online Journal Health Sciences. 2019; 5(1): 31-18.