Study On The Relationship Between The Phase Characteristics Of Seizure And Treatment And Outcome

Objective: The circadian rhythm is a biological phenomenon shared by individual organisms,and sleep-wake cycle is a prominent feature in the circadian rhythm.For a long time,people have realized that seizures are closely related to sleep-wake cycle.Previously,clinician in the United Kingdom classified patients with epilepsy(PWE)into diurnal,nocturnal,and diffuse based on the time of seizure.In clinical practice,about 1/3 of PWE only have seizures while awake,about 1/3 of PWE only have seizure while asleep,and the other 1/3 of PWE have seizures in both sleep and wakefulness.Some scholars have proposed that sleep may be used as an inducing event for seizures,and the relationship between the two is described as “bed-fellows”,which indicates that the brain may have some common mechanisms for sleep-wake cycle network regulation and epileptic network activation.In order to further clarify that there may be a shared electrophysiological mechanism between sleep-wake cycle and seizures,this study closely observes the possible relationship between seizures and sleep-wake cycle from a clinical perspective,as well as antiseizure medications(ASMs)in different phases of seizures,the response to the curative effect,and at the same time,observe the characteristics and laws of the phase transition of seizures.Methods: Using a combination of retrospective and prospective methods,collect the clinical history and clinical examination data of PWE in the outpatient,inpatient department and emergency department of the Epilepsy Center of Third Xiangya Hospital of Central South University.According to the purpose of this study,the following methods are used for statistical analysis:(1)The included PWE are divided into two groups according to the phase of seizures,namely the seizures while asleep(SWA)group and the non-seizures while asleep(NSWA)group.Determine the proportion of the SWA group in all PWE,and perform a comparison analysis between groups to find out the risk factors of the SWA group;(2)Follow-up of patients receiving ASMs treatment for the first time,collect their data of ASMs treatment and seizure frequency,use Kaplan-Meier method to calculate drug retention rate,and use Log Rank test analyzes the retention rate of different ASMs,and analyzes the effect of ASMs treatment through the chi-square test;(3)Follow-up of patients receiving ASMs treatment,collect their ASMs treatment and phase of seizure transition data,clarify the proportion of patients with seizure phase transition,and use single factor analysis and Binary Logistic Regression analysis to find out the risk factors of phase of seizure transition.Results: After the collection and follow-up of patients’ clinical data,the following results are obtained after statistical analysis:(1)50.3%(N=164)of the patients in PWE were SWA.The SWA group and the NSWA group had no difference in gender,age,age of onset,marital status,education,parental consanguineous marriage history,family history of epilepsy,history of febrile convulsion,and history of craniocerebral injury,seizure time,pre-onset aura and abnormal brain MRI(P>0.05);(2)There was no difference in the drug retention rate of SWA group after the first single drug treatment for 12 months(P = 0.533),and there was no difference in the drug retention rate of SWA group after 24 months(P = 0.556).There was no significant difference in the control rate of seizure frequency of different drugs after the first single drug treatment of ASMs(P=0.724).There was no difference in the drug retention rate of NSWA group after the first single drug treatment for 12 months(P = 0.550),and there was no difference in the drug retention rate of NSWA group after 24 months(P = 0.766).There was no significant difference in the control rate of seizure frequency of different drugs after the first single drug treatment of ASMs(P = 0.223).(3)19.1%(N=36)of patients with PWE who received ASMs monotherapy had seizure phase transition.The incidence of perinatal brain injury in the phase-shift group(16.7%)was higher than that in the non-phase-shift group(5.9%),and the difference was statistically significant(P=0.032).The incidence of craniocerebral injury in the phase-shift group(44.4%)was higher than that of the non-phase-shift group(27.0%),and the difference was statistically significant(P=0.040).The abnormal rate of craniocerebral MRI in the phase-shift group(52.8%)was higher than that of the non-phase-shift group(33.6%),and the difference was statistically significant(P=0.032).The results of binary logistic regression analysis showed that the history of perinatal brain injury(OR=0.236,95%CI:0.073-0.763)was a risk factor for the occurrence of epileptic seizures.Conclusion: Nearly half of the PWE were SWA,and there was no significant difference in common clinical features between the SWA group and the NSWA patients.Further molecular biology studies are needed to explore the risk factors of SWA.The SWA group PWE and NSWA group PWE received common ASMs for the first time.After drug treatment,there was no difference in the drug retention rate and therapeutic effect when different groups received the same drug treatment,and there was no difference in drug retention rate and treatment effect when the same group received different drug treatment;about 20% of patients received single drug Phase shifts occurred during treatment,with a higher likelihood of secondary PWE episodes.