Age-specific periictal electroclinical features of generalized tonic-clonic seizures and potential risk of sudden unexpected death in epilepsy (SUDEP).
Age-specific periictal electroclinical features of generalized tonic-clonic seizures and potential risk of sudden unexpected death in epilepsy (SUDEP).
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DOI：
10.1016/j.yebeh.2013.08.010
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发表时间：
2013-11
期刊：
影响因子：
--
通讯作者：
Lhatoo SD
中科院分区：
文献类型：
--
作者：
Freitas J;Kaur G;Fernandez GB;Tatsuoka C;Kaffashi F;Loparo KA;Rao S;Loplumlert J;Kaiboriboon K;Amina S;Tuxhorn I;Lhatoo SD
全身性强直阵挛发作（GTCS）是与癫痫猝死（SUDEP）相关的最常见的癫痫发作类型。本研究探讨了符号学和脑电图（EEG）的差异，在GTCS的成人相比，儿童。其基本原理在于流行病学观察，发现成人SUDEP的发病率高出10倍。我们分析了从癫痫监测中心招募的61名连续患者（12名儿童，23次癫痫发作和49名成人，82次癫痫发作）的105个GTCS的视频EEG数据。研究了其符号学、EEG和3导EKG特征。分析发作期癫痫发作持续时间，包括强直、阵挛、完全发作、发作后EEG抑制（PGES）和恢复期。分析发作前基线、发作期和发作后心率变异性（HRV）指标，包括RMSSD（R-R间期的均方根连续差）、SDNN（NN间期的标准差）和SDSD（差值的标准差）（包括低频/高频功率比）。广义估计方程（GEE）被用来寻找电临床特征之间的关联。在住院期间，对成人和儿童年龄组以及药物组（未停用抗癫痫药物与未改变或减少药物）进行了单独的亚组分析。成人和儿童癫痫发作存在较大差异，儿童癫痫发作的总持续时间、强直相、PGES和恢复相均明显较短（p<0.01）。使用强直相持续时间作为因变量的GEE分析发现年龄显著相关（p<0.001），并且在亚组分析（成人和儿童）期间仍然显著，因此强直相持续时间每增加0.12秒与PGES持续时间增加1秒相关。儿童的PGES持续时间平均短28秒。停药后，癫痫发作总持续时间显著延长，儿童平均延长8秒，成人平均延长11秒（p<0.05）。强直相持续时间也随着停药而显著增加，尽管PGES持续时间增加，但不显著。RMSSD与PGES持续时间呈负相关（较长的PGES持续时间与迷走神经介导的心率变异性降低相关; p<0.05），但与强直相持续时间无关。这项研究清楚地指出了成人和儿童GTCS之间可识别的电临床差异，这可能与解释儿童SUDEP风险较低有关。研究结果表明，一些延长的癫痫发作阶段和延长PGES持续时间可能是SUDEP风险的电临床标志物，值得进一步研究。
Generalized tonic-clonic seizures (GTCS) are the commonest seizure type associated with Sudden Unexplained Death in Epilepsy (SUDEP). This study examines semiological and electroencephalographic differences (EEG) in the GTCS of adults as compared to children. The rationale lies in epidemiological observations that have noted a ten-fold higher incidence of SUDEP in adults. We analyzed video-EEG data of 105 GTCS in 61 consecutive patients (12 children, 23 seizures and 49 adults, 82 seizures) recruited from the Epilepsy Monitoring Unit. Semiological, EEG and 3-channel EKG features were studied. Peri-ictal seizure phase durations were analyzed including tonic, clonic, total seizure, post-ictal EEG suppression (PGES) and recovery phases. Heart rate variability (HRV) measures including RMSSD (root mean square successive difference of R-R intervals), SDNN (standard deviation of NN intervals) and SDSD (standard deviation of differences) were analyzed (including low frequency/high frequency power ratios) during pre-ictal baseline, ictal and post-ictal phases. Generalized estimating equations (GEE) were used to find associations between electro-clinical features. Separate subgroup analyses were carried out on adult and pediatric age groups as well as medication groups (no anti-epileptic medication cessation versus unchanged or reduced medication) during admission. Major differences were seen in adult and pediatric seizures with total seizure duration, tonic phase, PGES and recovery phases being significantly shorter in children (p<0.01). GEE analysis using tonic phase duration as the dependent variable, found age to correlate significantly (p<0.001) and this remained significant during subgroup analysis (adults and children) such that each 0.12 second increase in tonic phase duration correlated with a 1 second increase in PGES duration. PGES durations were on average 28 seconds shorter in children. With cessation of medication, total seizure duration was significantly increased by a mean value of 8 seconds in children and 11 seconds in adults (p<0.05). Tonic phase duration also significantly increased with medication cessation and although PGES durations increased, this was not significant. RMSSD was negatively correlated with PGES duration (longer PGES durations were associated with decreased vagally mediated heart rate variability; p<0.05) but not with tonic phase duration. This study clearly points out identifiable electro-clinical differences between adult and pediatric GTCS that may be relevant in explaining lower SUDEP risk in children. The findings suggest that some prolonged seizure phases and prolonged PGES duration may be electro-clinical markers of SUDEP risk and merit further study.
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