Sleep and Epilepsy Syndromes
Sleep and Epilepsy Syndromes
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睡眠和癫痫综合症
作者：
B. Schmitt
摘要睡眠与癫痫关系密切。约20%的患者仅在夜间发作，约40%仅在白天发作，约35%在白天和夜间发作。在某些癫痫综合征中，癫痫发作的发生与睡眠或觉醒密切相关。婴儿痉挛主要出现在觉醒时，而心律失常有时仅在睡眠中可见。患有Panayiotopoulos综合征或良性癫痫伴中央颞区棘波（BECTS）的儿童大多在睡眠时癫痫发作，在这两种综合征中，发作间期棘波在慢波睡眠中明显加重。慢睡眠期间癫痫性电持续状态/睡眠期间连续棘波放电（ESES/CSWS）、非典型良性部分性癫痫和Landau-Kleffner综合征是癫痫性脑病，伴有大量行为和认知缺陷、各种癫痫发作和非快速眼动（NREM）睡眠期间的连续棘波活动。青少年肌阵挛性癫痫和癫痫大发作的特点是在觉醒后2小时内出现癫痫症状，通常由睡眠剥夺引起。夜间额叶癫痫有时被误认为是睡眠异常。当仔细观察临床症状和每晚和每月发作事件的频率并进行夜间视频脑电图（EEG）检查时，可以进行鉴别。睡眠脑电图记录可能有助于疑似癫痫和清醒脑电图不确定的患者。根据临床问题，睡眠记录应在午睡期间（自然睡眠或药物诱导），夜间或睡眠剥夺后进行。
Abstract Sleep and epilepsy have a close relationship. About 20% of patients suffer seizures only during the night, approximately 40% only during the day and approximately 35% during the day and night. In certain epilepsy syndromes, the occurrence of seizures is strongly related to sleep or awakening. Infantile spasms appear predominately on awakening, and hypsarrhythmia is sometimes visible only in sleep. Children with Panayiotopoulos syndrome or benign epilepsy with centrotemporal spikes (BECTS) have seizures mostly when asleep, and in both syndromes interictal spike waves are markedly accentuated in slow wave sleep. Electrical status epilepticus during slow sleep/continuous spike wave discharges during sleep (ESES/CSWS), atypical benign partial epilepsy, and Landau–Kleffner syndrome are epileptic encephalopathies with substantial behavioral and cognitive deficits, various seizures, and continuous spike–wave activity during non–rapid eye movement (NREM) sleep. The hallmark of juvenile myoclonic epilepsy and grand mal seizures on awakening are seizure symptoms within 2 hours after awakening, often provoked by sleep deprivation. Nocturnal frontal lobe epilepsy is sometimes mistaken for parasomnia. Differentiation is possible when the clinical symptoms and the frequency of the paroxysmal events per night and month are carefully observed and nocturnal video electroencephalography (EEG) performed. Sleep EEG recordings may be helpful in patients with suspected epilepsy and nonconclusive awake EEG. Depending on the clinical question, sleep recordings should be performed during nap (natural sleep or drug induced), during the night, or after sleep deprivation.