The Value Of Rapid Eye Movement Sleep In The Localization Of Epileptogenic Foci For Patients With Focal Epilepsy

Objective:Our aim was to investigate the value of rapid eye movement(REM)during prolonged scalp video-electroencephalography(VEEG)in the localization of epileptogenic foci for patients with focal epilepsy.Methods:We retrospectively studied a total of 59 patients with focal epilepsy and 31 of 59 received surgery.We assessed localization of interictal epileptiform discharges(IEDs)during REM,non–rapid eye movement sleep(NREM)and wakefulness to compare with the localization of ictal EEG,clinical semiology,magnetic resonance imaging(MRI)and positron emission tomography(PET)and stereo-electroencephalogram(SEEG).We graded postoperative follow-up outcome according to Engel criteria to further verify the accuracy of localization of epileptogenic foci in REM,NREM and Wakefulness.Results:1.Compared with the localization of NREM and wakefulness,REM-IEDs had the highest concordance rate of localization of epileptogenic foci with semiology(P = 0.008),MRI(P = 0.042),and PET-CT(P = 0.015),and the coincidence rate of localization with postoperatively confirmed epileptogenic foci was 74.2%(P = 0.03).The differences above were all statistically significant.2.The accuracy of REM localization in temporal epilepsy(90%)was higher than that extra-temporal epilepsy(54.5%),and the difference was statistically significant.3.REM non-accurate localization of epileptogenic foci was an independent risk factor contributing to poor prognosis(P=0.025,OR=12.368).Conclusion:1.Compared with NREM-IEDs and Wakefulness-IEDs,REM-IEDs had most value for localization of epileptogenic foci in patients with focal epilepsy.2.REM non-accurate localization of epileptogenic foci was an independent risk factor contributing to poor prognosis.