Abstract Details

Title Peak Seizure Frequency Correlates with Disruptive Spiking in Rapid Eye Movement Sleep

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) N3 - Neuroscience in the Clinic: Melatonin and Disrupted Sleep in Neurologic Disorders (4:35 PM-4:50 PM)

Poster/Presentation
Number 002

Objective To determine if peak seizure frequency correlates with the duration and/or amount of epileptiform activity during rapid eye movement (REM) sleep.

Background REM sleep usually suppresses interictal epileptiform discharges (IED) and seizures. However, when IEDs and seizures breakthrough in REM sleep, we hypothesize that these disruptive phenomena correlate with a more aggressive epilepsy course.

Design/Methods Retrospective chart and EEG review. Clipped EEG files from the epilepsy monitoring unit (EMU) over 12 months were analyzed for nightly REM sleep duration and “REM spike burden” (RSB), defined as the proportion of REM sleep occupied by IED or seizures. Charts were reviewed 2 years pre and post-EMU admission. Correlation analyses, logistic, and linear regressions were performed as appropriate. Multiple statistical comparisons were corrected using the Benjamini-Hochberg (BH) procedure.

Results 63 patients spent 6.4 mean days (1-12) in the EMU. Nightly median REM sleep duration was 43.3 minutes (IQR 20.9-73.2) per patient. 59/63 patients achieved REM sleep during EMU admission. 39/59 patients had breakthrough IEDs or seizures in REM sleep with median RSB 0.7% (IQR 0–8.4%). After controlling for covariates in multivariable regression, every 1% increase in RSB correlated with 1.69 (95% CI = 0.47-2.92) more seizures per month during the peak seizure period of one’s epilepsy (p=0.007). Subgroup analysis of 16 patients in a “steady-state” anti-seizure drug dosing regimen for ≥6 months showed a strong linear correlation between RSB and peak seizure frequency (Pearson r=0.9, BH-corrected p<0.0018).

Conclusions The degree of breakthrough disruptive epileptiform activity (IED or seizure) in REM sleep correlates with increased peak seizure frequency to suggest more severe epilepsy. Our findings suggest that RSB in the EMU may be a useful biomarker to help guide patients about what to expect over the course of one’s epilepsy, especially in the 2 years before and after an EMU admission.

Authors/Disclosures
Marcus Ng, MD (University of Manitoba) PRESENTER	The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Canada. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Paladin Canada. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai Canada. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Canada. Dr. Ng has received publishing royalties from a publication relating to health care.
Marna McKenzie	No disclosure on file
Michelle Lee Jones, MD (London Health Sciences Centre - UH)	No disclosure on file
Aoife M. O'Carroll, MD	No disclosure on file
	No disclosure on file
	No disclosure on file

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