The relationship between seizures, interictal spikes and antiepileptic drugs
The relationship between seizures, interictal spikes and antiepileptic drugs
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DOI：
10.1016/j.clinph.2016.05.014
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发表时间：
2016-09-01
影响因子：
4.7
通讯作者：
Zaveri, Hitten P.
中科院分区：
文献类型：
--
作者：
Goncharova, Irina I.;Alkawadri, Rafeed;Zaveri, Hitten P.
目的：在颅内脑电图 (icEEG) 监测期间，随着抗癫痫药物 (AED) 逐渐减量，峰值速率显着降低。由于 icEEG 监测期间的尖峰率可能受到颅内电极放置手术的影响，因此我们研究了长期头皮 EEG 监测期间的尖峰率，以进一步检验这一观察结果。方法：我们分析了 130 名连续患者平均 8.9 天（范围 5-17 天）的尖峰率、癫痫发作和 AED 逐渐减量。结果：我们观察到首次癫痫发作时间、尖峰率、 AED 逐渐减少和癫痫发作（F (3,126) = 19.77，p < 0.0001）。高峰值率与首次癫痫发作的时间较长有关。此外，在监测第 4 天或之后经历癫痫发作的 79 名患者中，峰值率最初从使用 AED 到关闭 AED 时期下降（从每小时 505.0 次峰值到 382.3 个峰值，p < 0.00001），此后随着癫痫发作的发生而增加。结论：癫痫发作、峰值和 AED 之间存在相互作用，使得峰值率随着 AED 逐渐减少而降低。 癫痫发作后增加。意义：峰值速率与 AED 之间以及峰值速率与首次癫痫发作时间之间的直接关系表明，峰值是抑制而不是兴奋的标志。 (C) 2016 年国际临床神经生理学联合会。由爱思唯尔爱尔兰有限公司出版。保留所有权利。
Objective: A considerable decrease in spike rate accompanies antiepileptic drug (AED) taper during intracranial EEG (icEEG) monitoring. Since spike rate during icEEG monitoring can be influenced by surgery to place intracranial electrodes, we studied spike rate during long-term scalp EEG monitoring to further test this observation.Methods: We analyzed spike rate, seizure occurrence and AED taper in 130 consecutive patients over an average of 8.9 days (range 5-17 days).Results: We observed a significant relationship between time to the first seizure, spike rate, AED taper and seizure occurrence (F (3,126) = 19.77, p < 0.0001). A high spike rate was related to a longer time to the first seizure. Further, in a subset of 79 patients who experienced seizures on or after day 4 of monitoring, spike rate decreased initially from an on-to off-AEDs epoch (from 505.0 to 382.3 spikes per hour, p < 0.00001), and increased thereafter with the occurrence of seizures.Conclusions: There is an interplay between seizures, spikes and AEDs such that spike rate decreases with AED taper and increases after seizure occurrence.Significance: The direct relationship between spike rate and AEDs and between spike rate and time to the first seizure suggests that spikes are a marker of inhibition rather than excitation. (C) 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.