不寧腿症候群在癲癇族群的危險因子及睡眠結構和睡眠品質評估
不寧腿症候群在癲癇族群的危險因子及睡眠結構和睡眠品質評估
不寧腿症候群是一個運動感覺失調且合併晝夜節律變化的疾病。其致病機轉仍然不明，目前最廣為接受的理論是多巴胺代謝失調以及腦部鐵含量的缺乏，其可能的病灶處為殼核和位於中腦的黑質。相反的，癲癇症是大腦皮質異常的同步放電。之前的研究很少討論到不寧腿症候群和癲癇的相關性，因此我們設計了一個病例對照研究去評估他們之間的關聯性。
24位有不寧腿症候群的癲癇病人作為病例組以及72個沒有不寧腿症候群的癲癇病人作為對照組。大部分的病人都有接受睡眠多項生理檢查、腦波連續錄影檢查以及睡眠問卷。睡眠問卷包含:匹茲堡睡眠質量表、愛普沃斯嗜睡量表、SF-36健康調查簡表以及醫院焦慮與憂鬱量表。另一方面，相關癲癇的特性和分類包含:致癲癇病灶、抗癲癇用藥、頑固性癲癇與否以及是否為夜間發作。睡眠結構和相關的睡眠事件都有進行分析，包含使用多變項羅吉斯回歸分析不寧腿候群和癲癇的相關性、獨立樣本t檢定和卡方檢定對於各種連續和類別變項進行分析，最後評估不寧腿症候群對於癲癇病人在睡眠品質和生活品質以及情緒上的影響。
經過多變項羅吉斯迴歸分析，在癲癇病人的族群裡頑固性癲癇(OR 6.422, P-value = 0.002)和夜間發作(OR 4.960, P-value = 0.005)為顯著的正相關危險因子，此外癲癇病人無論有無合併不寧腿症候群在睡眠檢查的參數並無太大的差異。在生活品質方面，合併不寧腿的癲癇病人在生理和心理方面的生活功能明顯遜於對照組，合併不寧腿症候群的癲癇族群也容易有白日嗜睡的現象。
在癲癇族群中，頑固性癲癇和夜間發作增加不寧腿症候群共病的機率。不寧腿症候群必須被視為癲癇病人可預期的共病症且應該避免將不寧腿的症狀誤診為癲癇發作的表現以致不恰當的抗癲癇藥使用。
應用與亮點：
1.對於癲癇族群而言頑固性癲癇和癲癇夜間發作和不寧腿症候群有很強的關聯性，不寧腿症候群必須被當作可預期的癲癇共病。
2.同時還有癲癇和不寧腿的病人要是有夜間肢體動作必須仔細區分是癲癇還是不寧腿症候群所引起，不洽當的增加抗癲癇藥劑量和增
加新的抗癲癇藥需要被避免。
3.控制良好的不寧腿症候群也可以讓癲癇控制更容易且改善睡眠品質、白日嗜睡和生理及心理上的日常生活品質。
【研究團隊】
團隊成員：李穎昇、葉威志、徐崇堯
代表單位：高雄醫學大學神經科學研究中心及高醫附院和大同醫院神經科
團隊簡介：本團隊致力於研究睡眠醫學相關致病機轉及危險因子
研究聯繫Email：cyhsu@kmu.edu.tw
【論文資訊】
論文出處：Sleep. 2023.Mar 1;zsad054
全文下載：https://pubmed.ncbi.nlm.nih.gov/36861219/
Restless Legs Syndrome in Patients with Epilepsy: Risk analysis, Polysomnography, and Quality of Life evaluation
Restless Legs Syndrome in Patients with Epilepsy: Risk analysis, Polysomnography, and Quality of Life evaluation
Restless legs syndrome (RLS) is a circadian rhythm related sensorimotor disorder due to brain iron deficiency, with lesion sites at the putamen and substantia nigra. However, epilepsy is a disease with abnormal electric discharge from the cortex and can be triggered with iron disequilibrium. We designed a case–control study to discover the association between epilepsy and RLS.
A total of 24 patients with epilepsy and RLS and 72 patients with epilepsy without RLS were included. Most of the patients underwent polysomnography and video electroencephalogram tests and took sleep questionnaires. We collected information on seizure characteristics, including general or focal onset, epileptogenic focus, current antiseizure medications, medically responsive epilepsy or refractory epilepsy, and nocturnal attacks. The sleep architectures of the two groups were compared. We analyzed the risk factors for RLS using multivariate logistic regression.
Among the patients with epilepsy, the occurrence of RLS was associated with refractory epilepsy (OR 6.422, P-value = 0.002) and nocturnal seizures (OR 4.960, P-value = 0.005). Sleep parameters were not significantly associated with RLS status. Quality of life was significantly impaired in the group with RLS in both the physical and mental domains.
Refractory epilepsy and nocturnal seizures were strongly correlated with RLS in patients with epilepsy. RLS should be considered a predictable comorbidity in patients with epilepsy. The management of RLS not only led to better control of the patient’s epilepsy but also improved their quality of life.
Application and Highlights:
1. For patients with epilepsy, refractory epilepsy and nocturnal seizures had strong links to RLS. RLS should be considered a predictable comorbidity for patients with epilepsy.
2. Epilepsy with RLS might have nocturnal paroxysmal symptoms related with RLS but not seizure per se. Thus, inappropriate dose increase or add-on of ASMs due to misidentification should be avoided.
3. Well-treated RLS helps patients with epilepsy gain better control of their condition and improves their nocturnal sleep quality, excessive daytime sleepiness, and physical and mental quality of life.
Research Team Members: Ying-Sheng Li, Wei-Chih Yeh, Chung-Yao Hsu
Representative Department: Neuroscience Research Center, Kaohsiung Medical University. Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan. Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital.
Introduction of Research Team:
The team has been committed to the risk factors and pathogenic mechanisms of sleep disorders.
Contact Email: cyhsu@kmu.edu.tw
Publication:Sleep. 2023.Mar 1;zsad054
Full-Text Article:https://pubmed.ncbi.nlm.nih.gov/36861219/
