Interictal spikes and epileptic seizures: their relationship and underlying rhythmicity
Interictal spikes and epileptic seizures: their relationship and underlying rhythmicity
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DOI：
10.1093/brain/aww019
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发表时间：
2016-04-01
期刊：
影响因子：
14.5
通讯作者：
Cook, Mark J.
中科院分区：
文献类型：
--
作者：
Karoly, Philippa J.;Freestone, Dean R.;Cook, Mark J.
我们报告了一项研究的定量分析，该研究从长时间的时间内获得了人类连续的门诊记录。这些目的是检查癫痫发作和自发的间隔尖峰的模式，彼此之间的关系以及周期性变化的性质。最初是为了癫痫发作预测而获得的记录数据，随后对进一步的分析进行了详细分析。检测算法确定了潜在的癫痫发作活性和模板匹配的过滤器来定位尖峰。癫痫发作事件被手动确认，并归类为临床相关，脑电图相同但在临床上相关或亚临床上的相同。我们发现，在15个受试者中，有9名在癫痫发作之前发生了显着改变。前峰值率提高与提高的可预测性有关。但是，峰值速率也显示在癫痫发作前会降低（在9名受试者中有6个）。峰值和癫痫发作的概率分布非常相似，即在癫痫发作可能性高的时候，癫痫尖峰的概率也增加了。峰值和癫痫发作都均显示出昼夜节律调节的明确证据，对于某些受试者，在数周到几个月内也可以看到长期的长期模式。峰值和癫痫发作的发生模式是高度特定的。峰值率的峰值降低与促进癫痫发作的尖峰不一致。但是，尖峰和癫痫发作表现出相似的概率分布的事实表明它们不是完全独立的过程。尖峰可能会积极抑制癫痫发作，或者峰值降低是大脑接近癫痫发作的次要症状。如果通过常见的调节因子调节峰值速率，则峰值可能是皮质兴奋性的有用的生物标志物。
We report on a quantitative analysis of electrocorticography data from a study that acquired continuous ambulatory recordings in humans over extended periods of time. The objectives were to examine patterns of seizures and spontaneous interictal spikes, their relationship to each other, and the nature of periodic variation. The recorded data were originally acquired for the purpose of seizure prediction, and were subsequently analysed in further detail. A detection algorithm identified potential seizure activity and a template matched filter was used to locate spikes. Seizure events were confirmed manually and classified as either clinically correlated, electroencephalographically identical but not clinically correlated, or subclinical. We found that spike rate was significantly altered prior to seizure in 9 out of 15 subjects. Increased pre-ictal spike rate was linked to improved predictability; however, spike rate was also shown to decrease before seizure (in 6 out of the 9 subjects). The probability distribution of spikes and seizures were notably similar, i.e. at times of high seizure likelihood the probability of epileptic spiking also increased. Both spikes and seizures showed clear evidence of circadian regulation and, for some subjects, there were also longer term patterns visible over weeks to months. Patterns of spike and seizure occurrence were highly subject-specific. The pre-ictal decrease in spike rate is not consistent with spikes promoting seizures. However, the fact that spikes and seizures demonstrate similar probability distributions suggests they are not wholly independent processes. It is possible spikes actively inhibit seizures, or that a decreased spike rate is a secondary symptom of the brain approaching seizure. If spike rate is modulated by common regulatory factors as seizures then spikes may be useful biomarkers of cortical excitability.