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Wakefulness-sleep modulation of EEG-EMG epileptiform activities: a quantitative study on a child with intractable
M Velasco1, F Velasco, H Alcalá
1Unit of Neurology and Neurosurgery, General Hospital SSA, Mexico City, Mexico.
Insights
Epilepsia partialis continua seizure activity in a child decreased during specific sleep stages. Seizure types B and C showed varied responses to transitions between wakefulness and different sleep stages, particularly paradoxical sleep.
Area of Science:
- Neuroscience
- Sleep Medicine
- Epileptology
Background:
- Continuous EEG and EMG monitoring was performed on a child with intractable epilepsia partialis continua.
- Depth electrodes were used for neuroaugmentive seizure control and simultaneous recording of sleep indicators.
Observation:
- Type B seizures involved isolated EEG sharp waves from the right Centromedian region (RCM sharp) and EMG jerks from the left deltoid muscle (LEMG jerks).
- Type C seizures comprised clusters of RCM sharp and LEMG jerks with poor EEG-EMG correlation.
- Sleep stages, including wakefulness (W), slow wave sleep (SWS I-III), and paradoxical sleep (PS), were analyzed.
Findings:
- Type B seizure activity (RCM sharp and LEMG jerks) decreased from wakefulness to SWS I and II.
- RCM sharp amplitude increased, while LEMG jerk amplitude decreased from SWS I/II to SWS III.
- All type B EEG-EMG activities significantly decreased during paradoxical sleep.
- Type C seizure occurrence decreased during PS, and duration varied across sleep stage transitions.
Implications:
- Sleep architecture significantly influences the expression of epilepsia partialis continua seizure activity.
- Understanding these sleep-EEG-EMG relationships can inform targeted neuroaugmentive therapies.
- Further research into sleep-specific seizure modulation may reveal novel treatment strategies for refractory epilepsy.
Abstract:
Continuous all night recordings of epileptiform EEG activities from right frontal scalp and thalamic Centromedian regions and EMG activities from left deltoid muscular region were performed on a child with intractable epilepsia partialis continua, with depth stimulating-recording electrodes used for neuroaugmentive seizure control. In addition, "normal" and "mature" sleep indicators in the same child were simultaneously recorded according to the International Procedures. During wakefulness (W), type B seizures consisted of isolated, high amplitude, negative-positive EEG sharp waves recorded from the right Centromedian region (RCM sharp) correlated with isolated bursts of high amplitude EMG potentials recorded from the left deltoid muscle (LEMG jerks). Type C seizures consisted of clusters of repetitive RCM sharp and LEMG jerks, where individual EEG-EMG activities showed poor correlations. Number and amplitude of type B RCM sharp and LEMG jerks significantly decreased when patient directly shifted from W to slow wave sleep I and II (SWSI and II). Number and amplitude of RCM sharp increased while those of LEMG jerks decreased directly from SWS I and II to slow wave sleep III (SWS III); all forms of EEG-EMG epileptiform type B activities significantly decreased directly or indirectly from W and SWS to paradoxical sleep (PS). Scalp EEG spikes from right frontal and central regions showed almost parallel changes to those of RCM sharp, except during SWS II, when amplitude increased in the former and decreased in the later. Occurrence of type C seizures only decreased during PS and duration decreased directly from SWS I to II and indirectly from SWS I to SWS II and PS; and from W to SWS II and III and PS.