EEG'de uyku evresinde görülen subklinik nöbetler ve fokal epilepsili hastalarda klinik önemi

Öz

Amaç: Çalışmalarda, subklinik nöbetlerin tanı, prognoz ve tedavi yanıtları üzerinde önemli bir etkisi olduğu gözlemlenmektedir. Çalışmamızın amacı, parsiyel epilepsi tanısı konmuş hastalarda bu nöbetlerin varlığını araştırmak, uyku ile ilişkilerini incelemek, tanıya katkılarını ve tedavi seçimi ile prognoz üzerindeki etkilerini değerlendirmektir. Materyal ve yöntem: EEG ünitesinde yapılan toplam 1,626 EEG incelendi. Bunların içinde, parsiyel epilepsi tanısı konmuş 626 hastaya ait EEG bulundu. Çalışmaya yirmi dakika EEG monitörizasyonu yapılan 140 hasta ve yirmi dört saat EEG monitörizasyonu yapılan 28 hasta dahil edildi. Bulgular: İki hasta grubu arasında karşılaştırmalı bir analiz yapıldı: biri yirmi dakika EEG'ye tabi tutulan diğeri 24 saat EEG monitörizasyonu yapılan. Dirençli epilepsi varlığında, SCS riski 3.1 kat artmaktadır. Frontal lob epilepsilerinde SCS varlığı, temporal lob epilepsilere kıyasla 2.2 kat daha yüksek bulundu (1,0-5,3). Levetirasetam kullanımı ile nöbetler arasında istatistiksel olarak anlamlı bir ilişki gözlemlendi (p=0,044). Risk oranı hesaplaması, Levetirasetam kullanımı ile nöbetlerin 1.2 kat (1-1.6) daha sık oluşma olasılığını gösterdi. Risk analizi, lakozamid-zonisamid gibi bilinen ilaçların kullanımı lehine nöbetlerin %1,5 kat (1,2-1,9) daha sık görüldüğünü ortaya koydu. Sonuç: Subklinik nöbetler, tanı, prognoz ve tedavi açısından giderek artan klinik öneme sahiptir. Bu nöbetlerin uyku ile ilişkisi, daha geniş hasta ve merkezlerle yapılacak gelecek araştırmalar için önem taşımaktadır.

Anahtar Kelimeler

• Subklinik nöbetler
• uyku
• fokal epilepsi

Subclinical seizures on EEG with sleep phases and clinical significance in patients with focal epilepsy

Öz

Purpose: Studies have observed that subclinical seizures significantly impact diagnosis, prognosis, and treatment responses. The aim of our study is to investigate the presence of these seizures, their relationship with sleep, their contribution to diagnosis, and their impact on treatment selection and prognosis in patients diagnosed with partial epilepsy. Materials and methods: A total of 1.626 EEGs conducted in the EEG unit were examined. Among them, 626 were found to belong to patients diagnosed with partial epilepsy. 140 patients who underwent twenty-minute EEG monitoring and 28 patients who underwent twenty-four-hour EEG monitoring were included in the study. Results: A comparative analysis was conducted between two cohorts of patients: one subjected to a twenty-minute EEG and the other undergoing a 24-hour EEG. In the presence of resistant epilepsy, the risk of SCS is increased by 3.1 times. The presence of SCS in frontal lobe epilepsies demonstrated a 2.2-fold elevation compared to temporal lobe epilepsies (1.0-5.3). A statistically significant relationship between Levetiracetam usage and seizures was observed (p=0.044). The calculated Odds Ratio for risk indicated a 1.2-fold (1-1.6) higher frequency of seizures with Levetiracetam usage. Risk analysis revealed a 1.5-fold (1.2-1.9) higher incidence of seizures with the use of well-known drugs in favor of lacosamide-zonisamide. Conclusion: SCSs are gaining increasing clinical significance in terms of diagnosis, prognosis, and treatment. The relationship between these periods of sleep and SCSs is important for future research with a larger number of patients and medical professionals.

Anahtar Kelimeler

• Subclinical seizures
• sleep
• focal epilepsy

Kaynakça

1. Zangaladze A, Nei M, Liporace JD, Sperling MR. Characteristics and clinical significance of subclinical seizures. Epilepsia. 2008;49(12):2016-2021. doi:10.1111/j.1528-1167.2008.01672.x
2. Velkey A, Siegler Z, Janszky J, Duray B, Fogarasi A. Clinical value of subclinical seizures in children with focal epilepsy. Epilepsy Res. 2011;95(1-2):82-85. doi:10.1016/j.eplepsyres.2011.03.001
3. Farooque P, Duckrow R. Subclinical seizures during intracranial EEG recording: are they clinically significant?. Epilepsy Res. 2014;108(10):1790-1796. doi:10.1016/j.eplepsyres.2014.09.020
4. Fernández Torre JL, Hernández Hernández M, Martino J, Hinojo C. Subclinical focal seizures as a sign of progression in gliomas. Epileptic Disord. 2014;16(4):546-553. doi:10.1684/epd.2014.0701
5. Vossel KA, Ranasinghe KG, Beagle AJ, et al. Incidence and impact of subclinical epileptiform activity in Alzheimer's disease. Ann Neurol. 2016;80(6):858-870. doi:10.1002/ana.24794
6. Jin B, Wang S, Yang L, et al. Prevalence and predictors of subclinical seizures during scalp video-EEG monitoring in patients with epilepsy. Int J Neurosci. 2017;127(8):651-658. doi:10.1080/00207454.2016.1220946
7. Anderson CT, Tcheng TK, Sun FT, Morrell MJ. Day-Night Patterns of Epileptiform Activity in 65 Patients With Long-Term Ambulatory Electrocorticography. J Clin Neurophysiol. 2015;32(5):406-412. doi:10.1097/WNP.0000000000000183
8. Cox BC, Khattak JF, Starnes K, et al. Subclinical seizures on stereotactic EEG: characteristics and prognostic value. Seizure. 2022;101:96-102. doi:10.1016/j.seizure.2022.07.015

9. la Fougère C, Rominger A, Förster S, Geisler J, Bartenstein P. PET and SPECT in epilepsy: a critical review. Epilepsy Behav. 2009;15(1):50-55. doi:10.1016/j.yebeh.2009.02.025
10. Frauscher B, Gotman J. Sleep, oscillations, interictal discharges, and seizures in human focal epilepsy. Neurobiol Dis. 2019;127:545-553. doi:10.1016/j.nbd.2019.04.007
11. Brotherstone R, McLellan A. Parasympathetic alteration during sub-clinical seizures. Seizure. 2012;21(5):391-398. doi:10.1016/j.seizure.2012.03.011
12. Akman CI, Montenegro MA, Jacob S, et al. Subclinical seizures in children diagnosed with localization-related epilepsy: clinical and EEG characteristics. Epilepsy Behav. 2009;16(1):86-98. doi:10.1016/j.yebeh.2009.06.026
13. Adjei P, Surges R, Scott CA, Kallis C, Shorvon S, Walker MC. Do subclinical electrographic seizure patterns affect heart rate and its variability?. Epilepsy Res. 2009;87(2-3):281-285. doi:10.1016/j.eplepsyres.2009.08.011
14. Puteikis K, Wolf P, Mameniškienė R. Longer-term verbal and visual memory patterns in patients with temporal lobe and genetic generalized epilepsies. Epilepsia Open. 2023;8(4):1279-1287. doi:10.1002/epi4.12779
15. Kanazawa K, Matsumoto R, Shimotake A, et al. Persistent frequent subclinical seizures and memory impairment after clinical remission in smoldering limbic encephalitis. Epileptic Disord. 2014;16(3):312-317. doi:10.1684/epd.2014.0664