Sleep-type seizures

Introduction Sleep-type epilepsy is a common seizure classification in epilepsy type. Its seizure time is in sleep. Its main clinical feature is sudden large behavioral abnormality during nighttime sleep. Common symptoms include sudden convulsions during sleep, mild general paralysis, and sleep-related aggressive behavior in a few cases.

Cause

1. Genetic factors. A family with a history of epilepsy or a congenital central nervous system or cardiac malformation is prone to occur.

2, brain damage and brain damage:

(1) Embryo-induced dysplasia caused by viral infection, radiation exposure or other causes during embryonic development;

(2) In the process of fetal production, birth injury is also a major cause of epilepsy;

(3) craniocerebral trauma.

3, other diseases of the brain: brain tumors, cerebrovascular disease, intracranial infections.

an examination

Related inspection

Brain CT examination EEG examination

Because sleep-type seizures occur during sleep, it is difficult for EEG to capture abnormal discharges. If necessary, 24-hour EEG can be used to monitor abnormal discharges in order to accurately detect abnormal discharge and assist sleep-epileptic epilepsy. diagnosis.

About 30% of EEG episodes were abnormally discharged during the episode of the frontal area. About half of the cases showed only anterior head rhythmic slow waves, and 10% of cases had epileptic EEG showing diffuse background activity flattening. . Only 11.8% of the EEG during the waking period showed epileptic discharge. PSG monitoring confirmed that the onset of the disease occurred in the slow wave sleep period (NREM stage 2 to 4), and there may be a small number of attacks during the awake period. More than half of the children had neuropsychiatric abnormalities during the day, including difficulty in awakening in the morning, fatigue, and excessive daytime sleepiness.

Studies have shown that about 25% to 30% of seizures occur mainly during sleep. Children with benign epilepsy with central sacral spine (BECT), arousal systemic tonic-clonic seizures, epilepsy with slow wave sleep continuous spike (CSWS).

Some scholars believe that sleep-type epilepsy is an autosomal dominant inheritance. A study in Australia has found that the CHRNA4 gene mutation at 20q13.2 to 13.3 is associated with this disease. Related reported therapeutic drugs include carbamazepine, clonazepam or lamotrigine. Most showed significant efficacy, manifested by a significant reduction or even complete termination of the seizure, and the discomfort of the daytime waking period decreased or disappeared. But the final treatment is still based on the actual condition of the clinician.

Once sleep-related epilepsy is diagnosed, regular anti-epilepsy treatment is usually required. Otherwise, recurrent episodes may affect neuropsychiatric function. Other sleep disorders, such as night terrors, nightmares, etc., generally do not require special treatment, and most have self-limiting characteristics. Some sleep disorders, such as narcolepsy, OSAS, require medication or device intervention, and the prognosis is mostly good.

Differential diagnosis

The familiarity with sleep-related epilepsy (shofar) is mainly in the differential diagnosis of other common sleep disorders to avoid erroneous treatment. The basic points of differential diagnosis are first of all familiar with the clinical characteristics of the above diseases. The key method for diagnosis is EEG examination, which is especially natural sleep EEG or long-term EEG monitoring. It is best to perform PSG examination at the same time. On the one hand, it can assist in the diagnosis of general sleep disorders. On the other hand, sleep-related epilepsy (shofar wind) can increase the detection rate of epileptiform discharge and help to determine its sleep cycle. relationship. In some sleep-related epilepsy (shofar), the frequency of epileptic discharges is closely related to the sleep cycle.

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