Częste wyładowania mózgowe podczas snu (powyżej 1%) związane z problemami z pamięcią i myśleniem u dorosłych pacjentów z epilepsją: badanie zależności dawka-efekt
Interictal epileptic discharge > 1% associated with cognitive impairment in adult patients with epilepsy: A cross-sectional study based on dose-response relationship and discharge characteristics
W skrócie
Badacze przeanalizowali zapisy aktywności elektrycznej mózgu u 114 dorosłych pacjentów z epilepsją i sprawdzili, jak częste wyładowania mózgowe wpływają na pamięć, myślenie i uwagę. Okazało się, że gdy wyładowania mózgowe zdarzają się ponad 1% czasu podczas snu, pacjenci wykazują gorszą pamięć, słabszą płynność słowną i problemy z uczeniem się. Wyniki sugerują, że monitorowanie wyładowań podczas snu może pomóc w przewidywaniu problemów poznawczych u pacjentów z epilepsją.
Oryginalny abstract (angielski)
BACKGROUND: Epilepsy is frequently accompanied by multidomain cognitive impairment, but the quantitative contribution of interictal epileptiform discharges (IEDs)-including discharge burden, vigilance state, and spatial distribution-to specific cognitive domains remains incompletely defined. OBJECTIVE: This cross-sectional study aimed to examine associations between multidimensional IED parameters and domain-specific cognitive function in non-symptomatic adult epilepsy. METHODS AND RESULTS: We analyzed long-term EEG-derived IED indices during sleep and wakefulness, lateralization, focal/multifocal distribution, and frontal/temporal involvement in 114 adults with non-symptomatic epilepsy, relating these metrics to a neuropsychological battery using ANCOVA with Benjamini-Hochberg false discovery rate (FDR) correction. After adjustment for age, education, disease duration, seizure duration, seizure frequency, and antiepileptic drug count, a sleep IED index > 1% remained associated with lower Montreal Cognitive Assessment, associative learning, and verbal fluency scores versus the < 1% group; Mini-Mental State Examination was borderline and visual recognition did not survive FDR. Compared with no discharge, sleep > 1% showed lower Digit Symbol and verbal fluency scores only at uncorrected significance. For wakefulness, no significant graded association emerged between < 1% and > 1% groups; versus no discharge, wake > 1% showed lower Digit Symbol and verbal fluency scores at uncorrected level only. Discharges during both sleep and wakefulness were associated with lower backward digit span than sleep-only discharges, with a trend after FDR. Lateralization and focal/multifocal distribution were not significantly associated after FDR. Frontal IEDs were associated with lower verbal fluency and attention-related scores versus no discharge, but direct regional contrasts were nonsignificant and limited by small subgroups. CONCLUSION: A sleep IED index > 1% may represent a candidate electrophysiological marker of domain-specific cognitive vulnerability, whereas a wakefulness threshold and clear regional specificity were not definitively established. These findings support vigilance-state-aware quantification of IED burden while highlighting the need for larger longitudinal studies with detailed medication profiling.