目标:在发育性和癫痫性脑病中,睡眠中存在尖峰波激活(DEE-SWAS),建议丘脑皮质网络在从局灶性癫痫发展为DEE-SWAS的病理生理学中起重要作用。Ethosuximide(ESM)通过阻断丘脑神经元的T型钙通道发挥作用。考虑到丘脑皮质网络,我们使用相位-振幅耦合(PAC)分析研究了DEE-SWAS治疗中ESM有效性的预测。
方法:我们回顾性招募了DEE-SWAS患儿,这些患儿在2009年1月至2022年9月期间记录了脑电图(EEG),并在冈山大学医院开了ESM处方。仅包括在睡眠期间EEG显示连续尖峰波的患者。我们从开始ESM之前记录的EEG中提取了5分钟非快速眼动睡眠阶段N2段。我们计算了调制指数(MI)作为成对组合的PAC的度量,该组合包括两种快速振荡类型之一(gamma,40-80Hz;波纹,80-150Hz)和五个慢波波段之一(delta,0.5-1、1-2、2-3和3-4Hz;θ,4-8Hz),并在ESM响应者和非响应者之间进行了比较。
结果:我们确定了20名诊断为DEE-SWAS的儿童服用ESM。15人是ESM响应者。关于伽马振荡,仅在前极和枕骨区域具有0.5-1Hz慢波的MI中观察到显着差异。关于涟漪,ESM响应者与额极区域的所有慢波耦合的MI明显较高,额叶区域的0.5-1、3-4和4-8Hz慢波,顶叶区域的3-4Hz慢波,枕骨区域的0.5-1、2-3、3-4和4-8Hz慢波,和3-4赫兹慢波在前颞区。
结论:大脑更广泛区域的高MI可能代表DEE-SWAS中丘脑介导的癫痫网络,并且可能是ESM有效性的预测因子。
OBJECTIVE: In developmental and epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS), the thalamocortical network is suggested to play an important role in the pathophysiology of the progression from focal epilepsy to DEE-SWAS. Ethosuximide (ESM) exerts effects by blocking T-type calcium channels in thalamic neurons. With the thalamocortical network in mind, we studied the prediction of ESM effectiveness in DEE-SWAS treatment using phase-amplitude coupling (PAC) analysis.
METHODS: We retrospectively enrolled children with DEE-SWAS who had an electroencephalogram (EEG) recorded between January 2009 and September 2022 and were prescribed ESM at Okayama University Hospital. Only patients whose EEG showed continuous spike-and-wave during sleep were included. We extracted 5-min non-rapid eye movement sleep stage N2 segments from EEG recorded before starting ESM. We calculated the modulation index (MI) as the measure of PAC in pair combination comprising one of two fast oscillation types (gamma, 40-80 Hz;
ripples, 80-150 Hz) and one of five slow-wave bands (delta, 0.5-1, 1-2, 2-3, and 3-4 Hz; theta, 4-8 Hz), and compared it between ESM responders and non-responders.
RESULTS: We identified 20 children with a diagnosis of DEE-SWAS who took ESM. Fifteen were ESM responders. Regarding gamma oscillations, significant differences were seen only in MI with 0.5-1 Hz slow waves in the frontal pole and occipital regions. Regarding
ripples, ESM responders had significantly higher MI in coupling with all slow waves in the frontal pole region, 0.5-1, 3-4, and 4-8 Hz slow waves in the frontal region, 3-4 Hz slow waves in the parietal region, 0.5-1, 2-3, 3-4, and 4-8 Hz slow waves in the occipital region, and 3-4 Hz slow waves in the anterior-temporal region.
CONCLUSIONS: High MI in a wider area of the brain may represent the epileptic network mediated by the thalamus in DEE-SWAS and may be a predictor of ESM effectiveness.