Miegs un epilepsija. Jurģis Strautmanis Bērnu neirologs
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1 Miegs un epilepsija Jurģis Strautmanis Bērnu neirologs
2 Multiplas mijiedarbības Miegs provocē lēkmes un interiktālas epileptiformas izlādes Miega deprivācija provocē lēkmes Epilepsija ietekmē miega kvalitāti Pretepilepsijas medikamenti ietekmē miega kvalitāti Miega traucējumi (parasomnijas) jāatšķir no epilepsijas lēkmēm Epilepsijas pacientiem ir paaugstināts miega traucējumu risks
3 Epilepsijas saistība ar nomoda miega ritmu Féré L., 1880.g. 2/3 lēkmju novērotas miegā Janz D., 1974.g pacienti ar ĢTKL 44% miegā 33% pamostoties (tikai 10% simptomātiskas) 23% dažādi Video EEG laikmets 43% parciālu lēkmju miegā (1. fāze 23%, 2. fāze 68%, nekad - REM) Sekundāra ģeneralizācija biežāk miegā (28%) nekā nomodā (18%) Mesiālas temporālas lēkmes retākas, frontālas biežākas Pieres daivas epilepsijas reti ģeneralizējas miegā Foldvary-Schaefer N, Sleep and Epilepsy, Semin Neurol. 2009;29(4):
4
5 Epilepsijas saistība ar nomoda miega ritmu Féré L., 1880.g. 2/3 lēkmju novērotas miegā Janz D., 1974.g pacienti ar ĢTKL 44% miegā 33% pamostoties (tikai 10% simptomātiskas) 23% dažādi Video EEG laikmets 43% parciālu lēkmju miegā (1. fāze 23%, 2. fāze 68%, nekad - REM) Sekundāra ģeneralizācija biežāk miegā (28%) nekā nomodā (18%) Mesiālas temporālas lēkmes retākas, frontālas biežākas Pieres daivas epilepsijas reti ģeneralizējas miegā Foldvary-Schaefer N, Sleep and Epilepsy, Semin Neurol. 2009;29(4):
6 «Miega» epilepsijas Sleep epilepsies Benign focal epilepsy of childhood with centro-temporal spikes Frontal lobe epilepsy Supplementary sensorimotor area Autosomal dominant nocturnal frontal lobe epilepsies Lennox Gastaut syndrome (tonic seizures) Epilepsy with continuous spike wave in sleep (CSWS) Awakening epilepsies Juvenile myoclonic epilepsy Absence epilepsy Epilepsy with grand mal seizures on awakening Foldvary-Schaefer N, Sleep and Epilepsy, Semin Neurol. 2009;29(4):
7 Bērnības epilepsija ar centrotemporāliem pīķiem Raustīšanās 1 sejas pusē (rokā) galvenokārt naktīs Saglabāta apziņa, bet nevar parunāt EEG izteikti pīķi abpusēji centro temporāli, pastiprinās miegā Mohammed A Al-Biltagi, Childhood epilepsy and sleep, World J Clin Pediatr 2014 August 8; 3(3): 45-53
8 Panayiotopoulos sindroms (agrīna vecuma idiopātiska okcipitāla epilepsija) 3-5 g. (1-10) Ictus emeticus (slikta dūša, rīstīšanās, vemšana 74%, 1-5 min., 3-5x) Citas veģetatīvas izpausmes bālums, piesārtums, cianoze, urīna vai fēču nesaturēšana, midriāze, mioze, hipersalivācija, cefāliskas auras, klepus, termoregulācijas traucējumi, zarnu kustību traucējumi, elpošanas un sirdsdarbības traucējumi Iktāla sinkope, uzvedības traucējumi, Samaņas traucējumi Acu deviācija 60-80%, hemikonvulsijas 26%, ģeneralizētas konvulsijas 20% Min. stundas, nepārtraukta vai intermitējoša EEG multifokāla asu viļņu aktivitāte 2-3 lēkmes dzīves laikā Bureau M et al, Epileptic syndromes in infancy, childhood and adolescence, JOHN LIBBEY EUROTEXT
9 Pieres daivas epilepsijas
10 Primārā motorā garoza Kontralaterālas vienkāršas parciālas motoras lēkmes ar kloniskām, miokloniskām vai toniskām kustībām Džeksona maršs Bieža sekundāra ģeneralizācija Postiktāla parēze Sheryl Haut, Frontal Lobe Epilepsy,
11 Papildus motorās zonas lēkmes (SMA) Īsas lēkmes (10-40 sek.) Asimetriska toniska roku poza (paukošanas, lateralizācija tajā pusē, kur saliekta roka) Apziņa saglabāta Var būt vokalizācijas un nespēja parunāt, grimases Bieži somatosensora aura! Lēkmes var būt sērijās Mohammed A Al-Biltagi, Childhood epilepsy and sleep, World J Clin Pediatr 2014 August 8; 3(3): Sheryl Haut, Frontal Lobe Epilepsy,
12 Dorsolaterālas lēkmes Kontralaterāla galvas un acu pagriešana Fokāla kloniska raustīšanās Sastingšana Automātismi Afāzija (dominējošā puslode) Samaņa saglabāta Sheryl Haut, Frontal Lobe Epilepsy,
13 Operkulāras lēkmes Vienkāršas parciālas motoras lēkmes ar raustīšanos sejā Rīšana, siekalošanās, košļāšana Garšas halucinācijas Runas traucējumi Bailes Epigastrāla aura Samaņas zudums Veģetatīvi simptomi Sheryl Haut, Frontal Lobe Epilepsy,
14 Frontopolāras lēkmes Pseido absansu lēkmes Agrīns un pilnīgs samaņas zudums Krišanas lēkmes, toniskas lēkmes, fokālas kloniskas lēkmes, sekundāri ģeneralizētas lēkmes Sheryl Haut, Frontal Lobe Epilepsy,
15 Orbitofrontālas lēkmes Hiperkinētiski automātismi Ožas halucinācijas Veģetatīvi simptomi Enurēze Bradikardija Sheryl Haut, Frontal Lobe Epilepsy,
16 Hipermotora frontāla lēkme, ventro mesiāla (HMS I)
17 Cingulārās daivas lēkmes Kompleksas parciālas lēkmes ar kompleksiem automātismiem Pamošanās Pedalēšnas kustības Veģetatīvi simptomi Vizuālas halucinācijas Sheryl Haut, Frontal Lobe Epilepsy,
18 McGonigal A, Frontal lobe epilepsy: seizure semiology and presurgical evaluation. Practical neurology, 2004, 4,
19 McGonigal A, Frontal lobe epilepsy: seizure semiology and presurgical evaluation. Practical neurology, 2004, 4,
20 Interiktālas epileptiformas izlādes un miegs 1947, Gibbs and Gibbs 500 EEG 36 % epi izlādes nomodā, 82% - miegā Parciālas epilepsijas Pastiprinās miega sākumā (kļūst biežākas, paplašinās lauks, var parādīties jauni perēkļi, kļūst difūzas) Visvairāk NREM1 NREM2 NREM3 Samazinās REM (noderīgi refraktārām T epilepsijām) CSWS un Landau Klefnera sindroms, Panajotopolos sindroms Primāri ģeneralizētas epilepsijas Izlādes pastiprinās miegā (NREM, samazinās REM) Izlādes pastiprinās pēc pamošanās Izlādes kļūst dezorganizētākas, pieaug amplitūda, samzinās frekvence, var parādīties polipīķi Foldvary-Schaefer N, Sleep and Epilepsy, Semin Neurol. 2009;29(4):
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