Zusammenfassung
Die sehr enge und ausgeprägte Beziehung zwischen zirkadianem Rhythmus und Epilepsie ist seit über einem Jahrhundert Gegenstand zahlreicher Untersuchungen. So konnten viele Einzelheiten der gegenseitigen Wechselwirkungen aufgeklärt werden und mittlerweile gibt es beträchtliches Wissen auf diesem Gebiet. Bei vielen Epilepsien werden Anfälle durch Schlaf oder Arousal aktiviert. Das Ausmaß dieser Aktivierung hängt von der Art der Epilepsie ab und ist bei den idiopathisch generalisierten Epilepsien am größten. Andererseits erhöht aber auch Schlafentzug die Wahrscheinlichkeit des Auftretens von Anfällen, wiederum bei bestimmten Epilepsiesyndromen häufiger als bei anderen. Bezogen auf das EEG kann interiktale epilepsietypische Aktivität häufiger im Schlaf gesehen werden, und zwar im Nonrapid-Eye-Movement-Schlaf. Neben einem Anstieg der Häufigkeit epilepsietypischer Potenziale kann auch deren Morphologie und Verteilung verändert werden, besonders bei generalisierten Potenzialen. Schlafentzug führt ebenfalls zu vermehrt auftretender epilepsietypischer Aktivität, sowohl im Wachen wie auch im Schlaf. Eine EEG-Ableitung nach Schlafentzug ist daher begründet, wenn bisherige Ableitungen Schlaf beinhalteten und keine epilepsietypischen Veränderungen zeigten. Dieser Übersichtsartikel stellt den Einfluss von Schlaf und Schlafentzug auf Anfälle und epilepsietypische Aktivität dar.
Abstract
The very close and strong relationship between the circadian rhythm and epilepsy has been studied for more than a century. Thus, numerous details of their mutual interactions have been elucidated, and meanwhile a considerable body of knowledge has emerged. In many epilepsy disorders, seizures are activated by sleep or arousal. The extent of this activation depends on the epilepsy syndrome, with idiopathic generalised epilepsies showing the greatest activation. On the other hand, sleep deprivation also enhances the likelihood of seizure occurrence, again more in certain epilepsy disorders than in others. With regard to to the EEG, interictal epileptiform abnormalities are seen more commonly during sleep, namely in the non-rapid eye movement sleep. Besides this increase in frequency, the morphology and distribution of epileptiform potentials, especially generalised ones, may be altered. Sleep deprivation also leads to more frequently occurring epileptiform activity, both in the awake and the sleep stages. Thus, it is reasonable to perform an EEG after sleep deprivation if the initial EEG recordings already included sleep and failed to show epileptiform potentials. This review covers the influence of sleep and sleep deprivation on epileptic seizures and epileptiform activity.
Schlüsselwörter
Schlaf - Schlafentzug - Schlafstörungen - Epilepsie - epilepsietypische Aktivität - EEG
Key words
sleep - sleep deprivation - sleep disorder - epilepsy - epileptiform activity - EEG
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Korrespondenzadresse
Dr. med. M. Hoppe
Abteilung für prächirurgische Intensivdiagnostik und Epilepsiechirurgie
EEG- und Video-Abteilung
Epilepsie-Zentrum Bethel
Krankenhaus Mara gGmbH
Maraweg 17–21
33617 Bielefeld
Email: Matthias.Hoppe@mara.de
