目的:非惊厥性癫痫持续状态(NCSE)表现为精神状态改变,无昏迷(NCSE)或昏迷NCSE。Hypocretin-1/orexin-A(H/O)参与警觉和睡眠维持。睡眠障碍和白天过度嗜睡(EDS)对认知功能和日常生活活动(ADL)有负面影响。
方法:符合NCSE标准的患者接受了脑脊液和脑磁共振成像检查,多导睡眠(PSG),多潜伏期睡眠测试(MSLT),并完成了Epworth嗜睡量表(ESS)。蒙特利尔认知评估用于评估认知功能,Barthel指数用于评估急性期(V1)和3个月随访(V2)的ADL。
结果:从2020年5月到2023年5月,我们招募了15名患者,八名(53.3%)女性,年龄中位数为69(14)岁。H/OCSF浓度中位数为250(63.6)pg/ml;然而,只有三个CSF样品(20%)降低到200μg/ml的临界浓度以下。15名患者中有14名(93.3%)完成了PSG研究。睡眠开始后的觉醒中位数为167(173.5)分钟,睡眠效率(SE)为62.9(63)%,睡眠潜伏期(SL)为6(32)分钟,REM睡眠为2.85(7.2)%,REM首次发作潜伏期为210.5(196.5)分钟。N1NREM阶段的中位数为4.65(15)%,N2NREM68.4(29.9)%,和N3NREM21.8(35.5)%。MSLT平均潜伏期为7.7(12.6)分钟。H/OCSF浓度与N1期NREM之间存在显着负相关(rs=-0.612,p=0.02),以及血氧饱和度低于90%的累计睡眠时间占总睡眠时间(TST)t90的比例(rs=-0.57,p=0.03)。MSLT与TST呈显著负相关(rs=-0.5369,p=0.0478),SE(rs=-0.5897,p=0.0265),呼吸暂停低通气指数(rs=-0.7631,p=0.0002)和脱氧指数(rs=-0.8009,p=0.0006)。MSLT和SL之间存在正相关(rs=0.6284,p=0.0161),ESS和t90之间存在正相关(rs=0.9014,p=0.0004)。H/OCSF浓度与EDS的相关性,认知表现,ADL没有得到证实。
结论:NCSE后患者表现出睡眠障碍和白天过度嗜睡。在这些病例中,Hypocretin-1/orexin-A浓度仅降低了20%。
OBJECTIVE: Nonconvulsive status epilepticus (NCSE) manifests as a change in mental status without a coma (NCSE proper) or comatose NCSE. Hypocretin-1/orexin-A (H/O) is involved in alertness and sleep maintenance. Sleep impairment and excessive daytime sleepiness (EDS) have a negative impact on cognitive functions and activities of daily living (ADL).
METHODS: Patients meeting the NCSE criteria underwent cerebrospinal fluid and brain magnetic resonance imaging examinations, polysomnographies (PSG), multiple latency sleep tests (MSLT), and completed Epworth Sleepiness Scale (ESS). Montreal Cognitive Assessment was used to evaluate cognitive functions, and the Barthel Index was used to assess ADL in the acute phase (V1) and three months follow-up (V2).
RESULTS: From May 2020 to May 2023, we enrolled 15 patients, eight (53.3 %) women, with a median age of 69 (14) years. The median H/O CSF concentration was 250 (63.6) pg/ml; however, only three CSF samples (20 %) decreased below the borderline concentration of 200 pg/ml. Fourteen out of 15 patients (93.3 %) completed the PSG study. The median of wakefulness after sleep onset was 167 (173.5) min, sleep efficiency (SE) was 62.9 (63) %, sleep latency (SL) was 6 (32) min, REM sleep was 2.85 (7.2) %, and REM first episode latency was 210.5 (196.5) minutes. The medians of the stages N1 NREM were 4.65 (15) %, N2 NREM 68.4 (29.9) %, and N3 NREM 21.8 (35.5) %. MSLT mean latency was 7.7 (12.6) minutes. A significant negative correlation exists between H/O CSF concentrations and the stage N1 NREM (rs = -0.612, p = 0.02), and the proportion of cumulative sleep time with oxygen saturation below 90 % in total sleep time (TST) t90 (rs = -0.57, p = 0.03). MSLT had significant negative correlation with TST (rs = -0.5369, p = 0.0478), with SE (rs = -0.5897, p = 0.0265), with apnea-hypopnea index (rs = -0.7631, p = 0.0002) and with deoxygenation index (rs = -0.8009, p = 0.0006). A positive correlation exists between MSLT and SL (rs = 0.6284, p = 0.0161) and between ESS and t90 (rs = 0.9014, p = 0.0004). The correlation between H/O CSF concentrations and EDS, cognitive performance, and ADL was not proved.
CONCLUSIONS: Patients after NCSE exhibited sleep impairment and excessive daytime sleepiness. Hypocretin-1/orexin-A concentrations decreased only in 20 % of these cases.