Volume 4, Issue 3 (Summer 2018)                   Caspian.J.Neurol.Sci 2018, 4(3): 98-107 | Back to browse issues page

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Mehvari Habibabadwi J, Zare M, Tabrizi N. Sleep-Related Seizures in Refractory Focal Epilepsy: Electroclinical Findings and Surgical Outcome. Caspian.J.Neurol.Sci 2018; 4 (3) :98-107
URL: http://cjns.gums.ac.ir/article-1-224-en.html
1- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran , mehvari@med.mui.ac.ir
2- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Abstract:   (2369 Views)
Background: Sleep Seizures (SSs) generally occur in refractory focal epilepsy, but their detailed characteristics and circadian patterns are still controversial. The effect of SSs on epilepsy surgery outcome has been addressed in few studies without definitive prognostic value.  
Objectives: This study investigated the characteristics of SSs and their prognosis in refractory focal epilepsy.
Materials & Methods: This retrospective cross-sectional study was conducted in the referral epilepsy center in Isfahan, Iran from 2011 to 2015. It investigated SSs in patients with refractory focal epilepsy who underwent pre-operative evaluation. Demographic data, electroclinical findings, pathology, and postsurgical outcomes were analyzed and compared to Wake Seizures (WSs).  Before the main analysis, Shapiro-Wilk test of normality was performed. Then the Independent sample t test, Chi-square test, Fisher’s exact test, Mann-Whitney U test and 1-way ANOVA were used to analyze the obtained data in SPSS. All probability tests were two-tailed and the level of significance was defined as P≤0.05.
Results: A total of 371 seizures in 113 patients were studied. The sleep/wake seizure ratio in Temporal Lobe Epilepsy (TLE) and Extratemporal Lobe Epilepsy (ETLE) were 0.54 and 0.91, respectively. The peak incidence of SSs in TLE and ETLE were during 4.00 to 8.00 and 0.00 to 4.00, respectively. SSs were considerably associated with EEG changes before clinical signs. Ictal EEG localization was more successful in SSs of extratemporal origin. Based on pathology findings, Focal Cortical Dysplasia (FCD) was highly associated with SSs. Left epileptogenic zone and FCD accompanied a less favorable outcome in SSs.
Conclusion: SSs are significantly more frequent in patients with ETLE and follow specific circadian patterns based on epileptogenic zone. Seizure semiology and EEG findings are in favor of more localized onset of epileptic activity in SSs of extratemporal origin. The side of epileptogenic zone, circadian pattern of seizures, well-defined epileptogenic lesion in MRI and pathology, could affect postsurgical outcomes in SSs.
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Type of Study: Research | Subject: Special
Received: 2017/11/28 | Accepted: 2018/03/25 | Published: 2018/07/1

1. Bazil CW. Sleep-related epilepsy. Curr Neurol Neurosci Rep. 2003; 3(2):167-72. [DOI:10.1007/s11910-003-0070-5] [PMID] [DOI:10.1007/s11910-003-0070-5]
2. DeWolfe JL, Malow B, Huguenard J, Stickgold R, Bourgeois B, Holmes GL. Sleep and epilepsy: A summary of the 2011 merritt-putnam symposium. Epilepsy Curr. 2013; 13(1):42-9. [DOI:10.5698/1535-7511-13.1.42] [PMID] [PMCID] [DOI:10.5698/1535-7511-13.1.42]
3. Díaz-Negrillo A. Influence of sleep and sleep deprivation on ictal and interictal epileptiform activity. Epilepsy Res Treat. 2013; 2013:492524. [DOI:10.1155/2013/492524] [DOI:10.1155/2013/492524]
4. Crespel A, Baldy-Moulinier M, Coubes P. The relationship between sleep and epilepsy in frontal and temporal lobe epilepsies: Practical and physiopathologic considerations. Epilepsia. 1998; 39(2):150–7. [DOI:10.1111/j.1528-1157.1998.tb01352.x] [PMID] [DOI:10.1111/j.1528-1157.1998.tb01352.x]
5. Herman ST, Walczak TS, Bazil CW. Distribution of partial seizures during the sleep-wake cycle: Differences by seizure onset site. Neurology. 2001; 56(11):1453–9. [DOI:10.1212/WNL.56.11.1453] [PMID] [DOI:10.1212/WNL.56.11.1453]
6. Goel D, Mittal M, Bansal KK, Srivastav RK, Singhal A. Sleep seizures versus wake seizures: A comparative hospital study on clinical, electroencephalographic and radiological profile. Neurol India. 2008; 56(2):151-5. [DOI:10.4103/0028-3886.41992] [PMID] [DOI:10.4103/0028-3886.41992]
7. Pavlova MK, Shea SA, Bromfield EB. Day/night patterns of focal seizures. Epilepsy Behav. 2004; 5(1):44-9. [DOI:10.1016/j.yebeh.2003.10.013] [PMID] [DOI:10.1016/j.yebeh.2003.10.013]
8. Pung T, Schmitz B. Circadian rhythm and personality profile in juvenile myoclonic epilepsy. Epilepsia. 2006; 47(Suppl 2):111-4. [DOI:10.1111/j.1528-1167.2006.00707.x] [PMID] [DOI:10.1111/j.1528-1167.2006.00707.x]
9. Durazzo TS, Spencer SS, Duckrow RB, Novotny EJ, Spencer DD, Zaveri HP. Temporal distributions of seizure occurrence from various epileptogenic regions. Neurology. 2008; 70(15):1265-71. [DOI:10.1212/01.wnl.0000308938.84918.3f] [PMID] [DOI:10.1212/01.wnl.0000308938.84918.3f]
10. Lüders H, Acharya J, Baumgartner C, Benbadis S, Bleasel A, Burgess R, et al. Semiological seizure classification. Epilepsia. 1998; 39(9):1006-13. [DOI:10.1111/j.1528-1157.1998.tb01452.x] [PMID] [DOI:10.1111/j.1528-1157.1998.tb01452.x]
11. Tonini C, Beghi E, Berg AT, Bogliun G, Giordano L, Newton RW, et al. Predictors of epilepsy surgery outcome: A meta-analysis. Epilepsy Res. 2004; 62(1):75-87. [DOI:10.1016/j.eplepsyres.2004.08.006] [PMID] [DOI:10.1016/j.eplepsyres.2004.08.006]
12. Bernasconi A, Andermann F, Cendes F, Dubeau F, Andermann E, Olivier A. Nocturnal temporal lobe epilepsy. Neurology. 1998; 50(6):1772-7. [DOI:10.1212/WNL.50.6.1772] [PMID] [DOI:10.1212/WNL.50.6.1772]
13. Hofstra WA, de Weerd AW. The circadian rhythm and its interaction with human epilepsy: A review of literature. Sleep Med Rev. 2009; 13(6):413-20. [DOI:10.1016/j.smrv.2009.01.002] [PMID] [DOI:10.1016/j.smrv.2009.01.002]
14. Hofstra WA, Gordijn MC, van der Palen J, van Regteren R, Grootemarsink BE, de Weerd AW. Timing of temporal and frontal seizures in relation to the circadian phase: A prospective pilot study. Epilepsy Res. 2011; 94(3):158-62. [DOI:10.1016/j.eplepsyres.2011.01.015] [PMID] [DOI:10.1016/j.eplepsyres.2011.01.015]
15. Hofstra WA, Grootemarsink BE, Dieker R, van der Palen J, de Weerd AW. Temporal distribution of clinical seizures over the 24-h day: A retrospective observational study in a tertiary epilepsy clinic. Epilepsia. 2009; 50(9):2019-26. [DOI:10.1111/j.1528-1167.2009.02044.x] [PMID] [DOI:10.1111/j.1528-1167.2009.02044.x]
16. Karafin M, St Louis EK, Zimmerman MB, Sparks JD, Granner MA. Bimodal ultradian seizure periodicity in human mesial temporal lobe epilepsy. Seizure. 2010; 19(6):347-51. [DOI:10.1016/j.seizure.2010.05.005] [PMID] [PMCID] [DOI:10.1016/j.seizure.2010.05.005]
17. Hofstra WA, Spetgens WP, Leijten FS, van Rijen PC, Gosselaar P, van der Palen J, et al. Diurnal rhythms in seizures detected by intracranial electrocorticographic monitoring: An observational study. Epilepsy Behav. 2009; 14(4):617-21. [DOI:10.1016/j.yebeh.2009.01.020] [PMID] [DOI:10.1016/j.yebeh.2009.01.020]
18. Jobst BC, Williamson PD, Neuschwander TB, Darcey TM, Thadani VM, Roberts DW. Secondarily generalized seizures in mesial temporal epilepsy: Clinical characteristics, lateralizing signs, and association with sleep-wake cycle. Epilepsia. 2001; 42(10):1279-87. [DOI:10.1046/j.1528-1157.2001.09701.x] [PMID] [DOI:10.1046/j.1528-1157.2001.09701.x]
19. Sinha S, Brady M, Scott CA, Walker MC. Do seizures in patients with refractory epilepsy vary between wakefulness and sleep. J Neurol Neurosurg Psychiatry. 2006; 77(9):1076–8. [DOI:10.1136/jnnp.2006.088385] [PMID] [PMCID] [DOI:10.1136/jnnp.2006.088385]
20. Losurdo A, Proserpio P, Cardinale F, Gozzo F, Tassi L, Mai R, et al. Drug-resistant focal sleep related epilepsy: Results and predictors of surgical outcome. Epilepsy Res. 2014; 108(5):953-62. [DOI:10.1016/j.eplepsyres.2014.02.016] [PMID] [DOI:10.1016/j.eplepsyres.2014.02.016]
21. Nobili L, Francione S, Mai R, Cardinale F, Castana L, Tassi L, et al. Surgical treatment of drug-resistant nocturnal frontal lobe epilepsy. Brain. 2007; 130(Pt 2):561-73. [DOI:10.1093/brain/awl322] [PMID] [DOI:10.1093/brain/awl322]
22. Nobili L, Cardinale F, Magliola U, Cicolin A, Didato G, Bramerio M, et al. Taylor's focal cortical dysplasia increases the risk of sleep-related epilepsy. Epilepsia. 2009; 50(12):2599-604. [DOI:10.1111/j.1528-1167.2009.02169.x] [PMID] [DOI:10.1111/j.1528-1167.2009.02169.x]
23. Tao Y, Guojun Z, Yuping W, Lixin C, Wei D, Yongjie L. Surgical treatment of patients with drug-resistant hypermotor seizures. Epilepsia. 2010; 51(10):2124-30. [DOI:10.1111/j.1528-1167.2010.02590.x] [PMID] [DOI:10.1111/j.1528-1167.2010.02590.x]
24. Blümcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A, et al. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia. 2011; 52(1):158-74. [DOI:10.1111/j.1528-1167.2010.02777.x] [PMID] [PMCID] [DOI:10.1111/j.1528-1167.2010.02777.x]

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