수면성 간질의 임상양상

Abstract

Background and Objectives: Nocturnal epilepsy is rare but an interesting phenomenon suggesting a close relationship between epilepsy and sleep. However, previous efforts to characterize the nocturnal epilepsy as a specific epileptic syndrome have been incomplete. This study was conducted to evaluate the prognosis and the recurrence rate of diurnal seizure in patients presented with nocturnal seizures only to further determine the clinical characteristics of nocturnal epilepsy. Methods: Sixty-six patients with nocturnal seizures only were identified through the epilepsy registry form of the Yonsei Epilepsy Clinic(YEC) Data Bank. All patients had thorough history, physical and neurological examinations, blood tests, sleep deprived EEG with nasopharyngeal electrodes, and MRI or CT of brain according to the protocol of YEC. Patients followed at the YEC shorter than one year were excluded from the data analysis. All patients included to the study were initially treated by maximally tolerable monotherapy and then polytherapy if seizures were not controlled. Results: Among sixty-six, patients, seizure descriptions were compatible with generalized tonic-clonic seizures in forty-seven patients and partial seizures with or without GTC in ninteen patients. EEG demonstrated either generalized or partial interictal epileptiform discharges in twenty-nine patients. CT or MRI showed focal lesions in eleven patients. For the follow up period of average thirty-nine months, twenty-five patients developed seizures while awake. Comparison of clinical characteristics between the patients with nocturnal seizures only and the patients with recurrent diurnal seizures did reveal followings ; duration of seizures at the time of initial evaluation was longer in the diurnal seizure (6. 7 vs. 9. 3 years), but it was not statistically significant (p<0.05). The presence of partial features in the history, neurological examinations, EEG, and MRI were more frequently associated with recurrent diurnal seizures. Responses to the AEDs