Why do seizures in generalized epilepsy often occur in the morning?
Why do seizures in generalized epilepsy often occur in the morning?
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DOI：
10.1212/wnl.0b013e3181ae7ca6
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发表时间：
2009-07-21
期刊：
影响因子：
9.9
通讯作者：
Berkovic, S. F.
中科院分区：
文献类型：
--
作者：
Badawy, R. A. B.;Macdonell, R. A. L.;Berkovic, S. F.
目的：我们使用经颅磁刺激研究昼夜变化对癫痫患者皮层兴奋性的影响。方法：30例药物初治癫痫患者（20例特发性全身性癫痫[IGE]，包括10例青少年肌阵挛性癫痫[JME]，10例局灶性癫痫）和10例对照组无癫痫。我们测量的平均运动阈值，并在短（2-15毫秒）和长（50 - 400毫秒）interstimulus intervals.Results：皮质兴奋性的增加表示减少短期和长期的皮质内抑制，观察到在早上与JME患者的下午相比。在其他IGE综合征中，仅皮质内长抑制减少。没有效果被发现在受试者与局灶性癫痫或对照无epileps.Conclusion：皮质兴奋性增加，经颅磁刺激测量清晨在特发性全身性癫痫患者，特别是在青少年肌阵挛性癫痫，但不与局灶性癫痫或对照无癫痫。这可能解释了该队列在一天中的这个时间段癫痫发作易感性增加。神经病学（R）2009; 73：218-222
Objective: We used transcranial magnetic stimulation to investigate the effect of diurnal variability on cortical excitability in patients with epilepsy.Methods: Thirty drug-naive patients with epilepsy (20 idiopathic generalized epilepsy [IGE], including 10 juvenile myoclonic epilepsy [JME], and 10 focal epilepsy) and 10 control subjects without epilepsy were studied both early in the morning and late in the afternoon. We measured the mean motor thresholds and constructed recovery curves at short (2-15 msec) and long (50 400 msec) interstimulus intervals.Results: An increase in cortical excitability indicated by decreased short and long intracortical inhibition was observed early in the morning compared to the afternoon in patients with JME. In other IGE syndromes, there was decreased long intracortical inhibition only. No effect was found in subjects with focal epilepsy or controls without epilepsy.Conclusion: Cortical excitability measured by transcranial magnetic stimulation increases early in the morning in patients with idiopathic generalized epilepsy, particularly in juvenile myoclonic epilepsy, but not in subjects with focal epilepsy or controls without epilepsy. This may explain the increased seizure susceptibility in this cohort at this time of day. Neurology (R) 2009; 73: 218-222