睡眠中的第一次发作:临床特征和预后
Nicholas D Lawn1, Elaine W Pang1, Judy Lee1
1Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia.
Epilepsia
|July 9, 2023
概括
在睡眠期间发生的首次未引起的发作比在清醒时发生的发作更容易复发. 复发通常也来自睡眠,并与较少的伤害相关,告知患者管理.
科学领域:
- 神经学 神经学
- 临床神经科学 临床神经科学
背景情况:
- 首次未引起的发作需要准确预测复发,以有效管理患者.
- 发作复发的确定的预测因素包括先前的脑损伤和脑电图 (EEG) 上的形异常.
- 睡眠在发作复发风险中的作用需要进一步研究.
研究的目的:
- 为了研究睡眠期间与清醒期间发生的首次未引起的发作和发作复发之间的关联.
- 为了确定睡眠发作是否是复发的独立预测因素.
- 为了比较睡眠和清醒发作之间的受伤风险和复发模式.
主要方法:
- 在2000年至2015年期间,对1312名成年人进行了前性队列研究,他们有史以来第一个未引起的发作.
- 临床特征和发作在睡眠和清醒期间发生的结果的比较.
- 生存分析以确定发作复发的独立预测因素.
主要成果:
- 在23%的患者中,第一次在睡眠期间发作发生,并且与清醒期间发作 (44.2%) 相比,在1年内复发的风险 (56.9%) 显著更高.
- 睡眠中的发作是复发的独立预测因素 (HR 1.44),类似于EEG异常和远程症状病因.
- 睡眠发作的复发也通常来自睡眠 (76%的第二次) 并与较低的受伤率相关.
结论:
- 从睡眠开始的首次未引起的发作与更高的复发可能性有关,独立于其他已知的危险因素.
- 睡眠发作事件后的后续发作也可能在睡眠期间发生.
- 这些发现对治疗决策和第一次发作后的患者咨询有影响.
相关概念视频
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