Özet:

In this study it was aimed to investigating the temporal distribution of the seizures of epileptic patients during the day and the relationship of their seizures with the stages of sleep by performing video monitorization for 5 days at Dokuz Eylül University School of Medicine, Department of Neurology Epilepsy and Sleep Center Laboratories. This study was conducted as a retrospective, non-interventional and descriptive research. Among patients who were investigated at Dokuz Eylül University School of Medicine, Department of Neurology Epilepsy and Sleep Center Laboratories from 2005 to 2011; 113 patients who were diagnosed as epilepsy and had 5 day video EEG images were selected and included in the study.  Age and sex of the patients, types of the seizures they experienced, the times at which these seizures happened and the numbers of seizures were evaluated as variables. The types of seizures of the patients were classified as: Partial, secondary, generalized, primary generalized and dialeptic. EEG pathologies were defined as: Temporal, frontal, generalized and normal EEG recordings.  Temporal distribution of the seizures were identified as: Group 1: 00.00-5.59, Group 2: 06.00-11.59, Group 3: 12.00-17.59, Group 4:18.00-23.59. EEG pathologies were classified according to ictal and interictal periods. Among 911 patients who were investigated at Epilepsy and Sleep Center Laboratories, 161 patients diagnosed as epilepsy and had 5 day video EEG images were selected, 113 of them were identified to have seizures and included in the study. There were 60 female (53 %) and 53 male (47 %) patients. Mean age of the patients was 28.56±11.7 years, total number of observed seizures was 497, mean duration of a seizure was calculated as 84.6 (2-560) seconds. As concerns the distribution of the types of seizures; 19.5 % were primer generalized, 45.1% were partial, 32.7% were secondary generalized and 2.7% were dialeptic. When the localization of epileptic discharges were examined on interictal EEG recordings during video EEG imaging follow-up, 50.4% of the patients had temporal, 15% had frontal and 8% had primary synchronized epileptic activity. The remaining 26.5% did not have any abnormal potential recorded. When the seizures monitored with video EEG imaging were evaluated in terms of their relationship with sleep; 24.8% happened while asleep, 19.5% while awake, 55.7% while both asleep and awake. Of the seizure types, partial and secondary generalized seizures happen more frequently during sleep and this ratio was found to be statistically significant (p<0.05). On video EEG recordings, in patients having temporal and frontal epileptic activity in the temporal distribution of the seizures based on ictal EEG pathology, the seizures showed a statistically significant increase from 00.00 to 05.59am.  Leaving temporal seizures aside, when generalized seizures were compared with other seizure types, they were more frequently observed from 06.00am to 11.59am.  When the relationship of seizure foci with sleep was investigated, 31% of the seizures stemming from frontal lobe, 25% of the seizures stemming from temporal lobe, and 7.7% of generalized seizures were experienced during sleep. 50% of the cases with normal EEG findings experienced their seizures during sleep as well. The data obtained from the study demonstrate that follow-up of three days with video imaging could be sufficient for diagnosis purposes. Furthermore, it is observed that the seizures had a distribution in relation with the stage of sleep. Temporal and frontal lobe seizures were more frequently seen from 00.00 to 05.59am. Sleep triggers the epileptic seizures and the microstructure of sleep decreases seizure threshold.

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