局灶性癫痫患者发作间期痫样放电昼夜变化规律的研究

A study on circadian rhythm of interictal epileptiform discharges in patients with localization related epilepsy

目的研究清醒睡眠节律对局灶性癫痫患者发作间期癫痫样放电（1iD）的影响。方法收集2011年1月至2012年1月，在北京三博脑科医院癫痫内科经过住院期间癫痫手术前综合评估的癫痫患者，共44例，采用电势定位的方法定位棘波最大电势点，作为棘波的位置，计数清醒期、快速眼动睡眠期（REM），非快速眼动睡眠I-Ⅱ期（NREMI-Ⅱ），和非快速眼动睡眠Ⅲ-Ⅳ期（NREMⅢ-IV）IID的次数和IID范围，用方差分析比较了各期的IID的次数和范围。结果IID的次数在NREMI-Ⅱ期（中位数：29次）和NREMⅢ-IV（中位数：56次），比REM期（中位数：1次）和清醒期（中位数：5次）明显增多（P〈0．05）。IID的分布范围用所涉及的电极个数计算，在NREMI-Ⅱ期[（1．06±0．85）个]和NREMⅢ-IV[（2．04±1．10）个]比REM期[（1．94±1．18）个]和清醒期[（0．86±0．66）个]明显增大（P〈0．05）。结论IID在NREMI-Ⅱ、NREM Ⅲ-Ⅳ期，出现频率最高，分布范围最广，在清醒期和REM期，IID出现频率明显降低，分布明显局限。

Objective To investigate the effects of circadian rhythm on interictal epileptiform discharges in patients with localization-related epilepsy. Methods Patients diagnosed with epilepsy in Sanbo Brain Hospital from January 2011 to January 2012 participated in this study. All patients were subjected to comprehensive evaluation, which included prolonged video-electroencephalogram （EEG） , magnetic resonance imaging. Intracranial electrodes,PET, SPECT were also adopted if necessary. Circadian rhythm was divided into four stages：REM,NREM I- II, NREM III-IV, and waking. The amount and distribution of IID were compared by ANOVA. Results Significant differences in the amount and distribution of IID were found among NREM I-II, NREM III-IV, REM, and waking. However,no differences in the amount and distribution of IID were noted between NREM I-II and NREM III-IV as well as between REM and waking. Conclusion The amount of IID is higher in NREM than in REM and waking ; thus, NREM is more sensitive to diagnose epilepsy. The distribution of IID in REM and waking is more restricted than that in NREM.