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Huijben IAM, van Sloun RJG, Hoondert B, Dujardin S, Pijpers A, Overeem S, van Gilst MM. Temporal dynamics of awakenings from slow-wave sleep in non-rapid eye movement parasomnia. J Sleep Res 2024; 33:e14096. [PMID: 38069589 DOI: 10.1111/jsr.14096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/29/2023] [Accepted: 10/29/2023] [Indexed: 05/15/2024]
Abstract
Non-rapid eye movement parasomnia disorders, also called disorders of arousal, are characterized by abnormal nocturnal behaviours, such as confusional arousals or sleep walking. Their pathophysiology is not yet fully understood, and objective diagnostic criteria are lacking. It is known, however, that behavioural episodes occur mostly in the beginning of the night, after an increase in slow-wave activity during slow-wave sleep. A better understanding of the prospect of such episodes may lead to new insights in the underlying mechanisms and eventually facilitate objective diagnosis. We investigated temporal dynamics of transitions from slow-wave sleep of 52 patients and 79 controls. Within the patient group, behavioural and non-behavioural N3 awakenings were distinguished. Patients showed a higher probability to wake up after an N3 bout ended than controls, and this probability increased with N3 bout duration. Bouts longer than 15 min resulted in an awakening in 73% and 34% of the time in patients and controls, respectively. Behavioural episodes reduced over sleep cycles due to a reduction in N3 sleep and a reducing ratio between behavioural and non-behavioural awakenings. In the first two cycles, N3 bouts prior to non-behavioural awakenings were significantly shorter than N3 bouts advancing behavioural awakenings in patients, and N3 awakenings in controls. Our findings provide insights in the timing and prospect of both behavioural and non-behavioural awakenings from N3, which may result in prediction and potentially prevention of behavioural episodes. This work, moreover, leads to a more complete characterization of a prototypical hypnogram of parasomnias, which could facilitate diagnosis.
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Affiliation(s)
- Iris A M Huijben
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Onera Health, Eindhoven, The Netherlands
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | | | | | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
| | - Merel M van Gilst
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
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2
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Correa VM, Vitrai J, Szűcs A. Parasomnias manifest different phenotypes of sleep-related behaviors in age and sex groups. A YouTube-based video research highlighting the age slope of sleepwalking. J Clin Neurosci 2024:S0967-5868(24)00104-8. [PMID: 38508886 DOI: 10.1016/j.jocn.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
STUDY OBJECTIVE Finding typical patterns - phenotypes - of sleep behaviors characterizing parasomnias in different age and sex groups. METHODS We analyzed YouTube videos on sleep-related behaviors likely representing parasomnias. We applied the search terms "sleepwalking", "somnambulism", "sleep eating" "sleep sex", "sleep talking" and "aggression in sleep" in six languages. We classified those persons shown on the videos into estimated biological sex and age (child, adult, elderly) groups. We scored the activity types by a self-made scale and applied binary logistic regression to analyze the association between sleep behaviors versus sex and age groups by the STATA package, providing a 95 % confidence interval and the probability of statistical significance. RESULTS 224 videos (102 women; 68 children, 116 adults, and 40 elderly people) were scored. Elderly people had significantly (P < 0.012) less odds of ambulation in sleep likely consistent with somnambulism compared to adults and children. Adult females performed complex manual activities during sleepwalking more often, than males (P < 0.012). Elderly males had 40-fold odds compared to adults and children, to perform aggressive movements and 70-fold odds of complex movements in bed, compared to adults. Elderly people presented emotional behaviors less frequently than adults (P < 0.004), and females showed them twice as often as males. Adults sleep-talked full sentences more often than children and elderly people (P < 0.001). CONCLUSION Our results support the existence of age- and sex-specific parasomnia phenotypes, denoting possible safety measures. The remarkably low odds of sleepwalking in the elderly highlight the possibility of different pathomechanisms in higher age groups compared to children.
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Affiliation(s)
- Vivian M Correa
- Mental Health Sciences 'Doctoral School, Semmelweis University, Budapest, Hungary.
| | - József Vitrai
- Department of Preventive Health Science, Széchenyi University of Győr, Hungary
| | - Anna Szűcs
- Department of Behavioral Sciences, Mental Health, Semmelweis University, Budapest, Hungary
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3
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Kang MK, Shin DS, Lee HC, Provini F, Jung KY. A case of disorder of arousal with prolonged postarousal hypersynchronous delta activity. J Clin Sleep Med 2023; 19:1365-1368. [PMID: 36872654 PMCID: PMC10315606 DOI: 10.5664/jcsm.10548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Disorder of arousal (DOA) is a form of non-rapid eye movement sleep parasomnia caused by partial or incomplete arousal from deep sleep. Most previous studies of patients with DOA analyzed prearousal hypersynchronous delta activity (HSDA), but few studies have described postarousal HSDA. Herein, we report a 23-year-old man with a history of abrupt arousal during sleep and confused behavior and speech since he was 14 years old. During video electroencephalography monitoring, he had 9 arousal events of getting up, sitting on the bed, looking around, or simple arousal, including eyes open, looking at the ceiling, or head flexion. During all arousal events, the postarousal electroencephalography pattern was prolonged HSDA for approximately 40 seconds. The patient was treated unsuccessfully for more than 2 years with an antiseizure medication (lacosamide); eventually, he responded to clonazepam that was administered for the possibility of DOA. Prolonged rhythmic HSDA without spatiotemporal evolution can appear as a postarousal electroencephalography pattern of DOA. When diagnosing DOA, it is important to recognize that postarousal HSDA can appear as a characteristic electroencephalography pattern of DOA. CITATION Kang M, Shin D, Lee HC, Provini F, Jung KY. A case of disorder of arousal with prolonged postarousal hypersynchronous delta activity. J Clin Sleep Med. 2023;19(7):1365-1368.
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Affiliation(s)
- Mi-kyoung Kang
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Dae-seop Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Chang Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Laboratory for Neurotherapeutics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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4
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Mainieri G, Loddo G, Provini F, Nobili L, Manconi M, Castelnovo A. Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults. Diagnostics (Basel) 2023; 13:diagnostics13071261. [PMID: 37046480 PMCID: PMC10093221 DOI: 10.3390/diagnostics13071261] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.
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Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype? J Clin Med 2023; 12:jcm12010372. [PMID: 36615171 PMCID: PMC9821298 DOI: 10.3390/jcm12010372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.
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Puligheddu M, Congiu P, Figorilli M, Tamburrino L, Pisanu P, Coa R, Mascia MG, Fonti D, Lecca R, Grossi E, Gagliano A. Neuropsychological and Behavioral Profile in Sleep-Related Hypermotor Epilepsy (SHE) and Disorders of Arousal (DOA): A Multimodal Analysis. J Clin Med 2023; 12:jcm12010374. [PMID: 36615172 PMCID: PMC9820873 DOI: 10.3390/jcm12010374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
STUDY OBJECTIVES Disorder of arousal (DOA) and sleep-related hypermotor epilepsy (SHE) are complex, often bizarre, involuntary sleep behaviors, whose differential diagnosis may be challenging because they share some clinical features, such as sleep fragmentation. Mounting evidence highlights the critical role of sleep in cognitive functions. Controversial findings are raised about the cognitive profile in SHE; however, no studies have investigated the cognitive profile in DOA. This study aimed to assess whether sleep instability affects cognitive functions in patients with SHE or DOA. METHODS This study analyzed 11 patients with DOA, 11 patients with SHE, and 22 healthy controls (HC). They underwent full-night video polysomnography (vPSG) and comprehensive neuropsychological and behavioral evaluation. Differences in the variables of interest among the SHE group, DOA group, and their respective control groups were evaluated. The auto-contractive map (auto-CM) system was used to evaluate the strength of association across the collected data. RESULTS The SHE group had reduced sleep efficiency and increased wake after sleep onset (WASO); both the SHE and DOA groups showed increased % of N2 and REM sleep compared to the HC group. Neuropsychological and behavioral evaluations showed a different cognitive profile in the SHE group with respect to the HC group. The auto-CM showed that Pittsburgh Sleep Quality Index (PSQI), Beck depression inventory (BDI), MWCST_PE, Epworth sleepiness scale (ESS), WASO, N1, and % REM were strictly correlated with SHE, whereas the SE and arousal index (AI) were strictly related to DOA. CONCLUSIONS Patients with SHE and DOA present different cognitive and psychiatric profiles, with subtle and selective cognitive impairments only in those with SHE, supporting the discriminative power of cognitive and psychiatric assessment in these two conditions.
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Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
- Correspondence: ; Tel.: +39-0706754952
| | - Patrizia Congiu
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Michela Figorilli
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Patrizia Pisanu
- UOC Riabilitazione Funzionale e Neuroriabilitazione, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Roberta Coa
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | | | - Davide Fonti
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Foundation, 22038 Tavernerio, Italy
| | - Antonella Gagliano
- Unità di Neuropsichiatria dell’infanzia e dell’adolescenza, Dipartimento di Scienze Biomediche, Università di Cagliari & Ospedale Pediatrico, 09100 Cagliari, Italy
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7
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Pimentel LH, Mutarelli EG. Diagnostic pitfalls in functional neurological disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:324-327. [PMID: 35976310 PMCID: PMC9491422 DOI: 10.1590/0004-282x-anp-2022-s120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The diagnosis of functional neurological disorders is a major challenge in neurologist practice. Some clinical strategies can facilitate the recognition of functional disorders, but several pitfalls make their diagnosis difficult. Here we highlight the following points of attention during evaluation of patients with functional disorder: not all bizarre behavior is functional; not every event triggered by an emotional factor is a functional disorder; not every topographic incongruity is a functional disorder; patients may present functional and organic symptoms at the same time; psychiatric comorbid condition is not always evident in the history of a functional disorder; problematic communication at the time of diagnosis can compromise treatment and prognosis. In conclusion, we emphasize that special attention to these possible pitfalls facilitate the correct diagnosis and management of functional neurological disorders.
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Affiliation(s)
- Lucio Huebra Pimentel
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
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8
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Nobili L, Frauscher B, Eriksson S, Gibbs SA, Halasz P, Lambert I, Manni R, Peter-Derex L, Proserpio P, Provini F, de Weerd A, Parrino L. Sleep and epilepsy: A snapshot of knowledge and future research lines. J Sleep Res 2022; 31:e13622. [PMID: 35487880 PMCID: PMC9540671 DOI: 10.1111/jsr.13622] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Sleep and epilepsy have a reciprocal relationship, and have been recognized as bedfellows since antiquity. However, research on this topic has made a big step forward only in recent years. In this narrative review we summarize the most stimulating discoveries and insights reached by the "European school." In particular, different aspects concerning the sleep-epilepsy interactions are analysed: (a) the effects of sleep on epilepsy; (b) the effects of epilepsy on sleep structure; (c) the relationship between epilepsy, sleep and epileptogenesis; (d) the impact of epileptic activity during sleep on cognition; (e) the relationship between epilepsy and the circadian rhythm; (f) the history and features of sleep hypermotor epilepsy and its differential diagnosis; (g) the relationship between epilepsy and sleep disorders.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatric Unit, Istituto G. Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sofia Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Steve Alex Gibbs
- Department of Neurosciences, Center for Advanced Research in Sleep Medicine, Sacred Heart Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Isabelle Lambert
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.,APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, CNRS UMR 5292/INSERM U1028, Lyon, France
| | - Paola Proserpio
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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9
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Bergmann M, Brandauer E, Stefani A, Heidbreder A, Unterberger I, Högl B. The additional diagnostic benefits of performing both video-polysomnography and prolonged video-EEG-monitoring: when and why. Clin Neurophysiol Pract 2022; 7:98-102. [PMID: 35330982 PMCID: PMC8938868 DOI: 10.1016/j.cnp.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022] Open
Abstract
Video-polysomnography (VPSG) and prolonged video-EEG-monitoring (pVEEG-M) are indicated for different suspected diagnoses. Here, we report on 109 patients who underwent both, VPSG and pVEEG-M, within a 10 year period. Both examinations were performed in case of comorbidities, to achieve a final diagnosis or to refute differential diagnoses.
Objective Video-polysomnography (VPSG) and prolonged video-EEG-monitoring (pVEEG-M) are neurophysiological investigation modalities. Depending on indication either is performed, but occasionally patients undergo both (during the same or separate stays). We sought to assess the reasons and potential benefits of dual diagnostic assessments with both modalities. Methods A retrospective chart-review was performed to identify patients who underwent both VPSG and pVEEG-M during the 10 year period between 2007 and 2017. One-hundred-nine patients were identified who had undergone both studies. Patients were grouped according to indication and outcome. Results One-hundred-nine patients had both, a VPSG and pVEEG-M, in 62 (56.9%) the studies were performed because of separate diagnoses independent from each other. In 47 patients (43.1%) investigation with both modalities was needed to clarify the suspected diagnosis or to refute differential diagnoses. Out of these 47, 11 (10.1% of the whole group) arrived a new final diagnosis whereas in 36 (33%) the primary diagnosis was corroborated with the second modality. Conclusions In the majority of cases VPSG plus pVEEG-M were indicated to diagnose or monitor different comorbid diseases (e.g. sleep-related breathing disorder and epilepsy). In the other cases, performing both modalities was useful to achieve a higher diagnostic accuracy or to refute differential diagnoses. Significance VPSG and pVEEG-M are neurophysiological investigations which complement each other, especially in case of two different comorbid diseases in a single patient, to rule out differential diagnosis or when a higher diagnostic certainty is seeked.
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10
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Lai W, Du D, Chen L. Metabolomics Provides Novel Insights into Epilepsy Diagnosis and Treatment: A Review. Neurochem Res 2022; 47:844-859. [PMID: 35067830 DOI: 10.1007/s11064-021-03510-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/04/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
Epilepsy is one of the most common diseases of the central nervous system. The diagnosis of epilepsy mainly depends on electroencephalograms and symptomatology, while diagnostic biofluid markers are still lacking. In addition, approximately 30% of patients with epilepsy (PWE) show a poor response to the currently available anti-seizure medicines. An increasing number of studies have reported alterations in the blood, brain tissue, cerebrospinal fluid and urine metabolome in PWE and animal models of epilepsy. The aim of this review was to identify potential metabolic biomarkers and pathways that might facilitate diagnostic, therapeutic and prognostic determination in PWE and the understanding of the pathogenesis of the disease. The PubMed and Embase databases were searched for metabolomic studies of PWE and epileptic models published before December 2020. The study objectives, types of models and reported differentially altered metabolites were examined and compared. Pathway analyses were performed using MetaboAnalyst 5.0 online software. Thirty-five studies were included in this review. Metabolites such as glutamate, lactate and citrate were disturbed in both PWE and epileptic models, which might be potential biomarkers of epilepsy. Metabolic pathways including alanine, aspartate and glutamate metabolism; glycine, serine and threonine metabolism; glycerophospholipid metabolism; glyoxylate and dicarboxylate metabolism; and arginine and proline metabolism were involved in epilepsy. These pathways might play important roles in the pathogenesis of the disease. This review summarizes metabolites and metabolic pathways related to epilepsy and provides a novel perspective for the identification of potential biomarkers and therapeutic targets for epilepsy.
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Affiliation(s)
- Wanlin Lai
- Department of Neurology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Dan Du
- West China-Washington Mitochondria and Metabolism Center, Advanced Mass Spectrometry Centre, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Lei Chen
- Department of Neurology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, People's Republic of China.
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11
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Wan H, Wang X, Chen Y, Jiang B, Chen Y, Hu W, Zhang K, Shao X. Sleep-Related Hypermotor Epilepsy: Etiology, Electro-Clinical Features, and Therapeutic Strategies. Nat Sci Sleep 2021; 13:2065-2084. [PMID: 34803415 PMCID: PMC8598206 DOI: 10.2147/nss.s330986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
Sleep-related hypermotor epilepsy (SHE) is a group of clinical syndromes with heterogeneous etiologies. SHE is difficult to diagnose and treat in the early stages due to its diverse clinical manifestations and difficulties in differentiating from non-epileptic events, which seriously affect patients' quality of life and social behavior. The overall prognosis for SHE is unsatisfactory, but different etiologies affect patients' prognoses. Surgical treatment is an effective method for carefully selected patients with refractory SHE; nevertheless, preoperative assessment remains challenging because of the low sensitivity of noninvasive scalp electroencephalogram and imaging to detect abnormalities. However, through a careful analysis of semiology, the clinician can deduce the potential epileptogenic zone. This paper summarizes the research status of the background, etiology, electro-clinical features, diagnostic criteria, prognosis, and treatment of SHE to provide a more in-depth understanding of its pathophysiological mechanism, improve the accuracy in the diagnosis of this group of syndromes, and further explore more targeted therapy plans.
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Affiliation(s)
- Huijuan Wan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China.,Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, People's Republic of China
| | - Xing Wang
- Department of Neurology, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing, People's Republic of China
| | - Yiyi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
| | - Bin Jiang
- Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, People's Republic of China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
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