抗癫痫药物负荷与癫痫传播早期终止无相关性
Anti-seizure medication load is not correlated with early termination of seizure spread
AI总结：
本研究通过颅内脑电图和药代动力学模型，发现抗癫痫药物浓度与癫痫传播早期终止无显著关联，提示药物缩短发作时长可能通过独立于阻断传播的机制实现。
摘要：
目的：抗癫痫药物（ASMs）是癫痫治疗的主要手段，但其对癫痫传播的影响尚未完全阐明。较高的ASM剂量与较短且较轻的癫痫发作相关。我们旨在检验这种效应是否通过早期终止原本不变的癫痫传播来限制其扩散。方法：我们回顾性检查了15名在术前监测期间进行ASM减量的受试者的颅内脑电图（iEEG）记录。我们基于药代动力学模型估计了ASM血浆浓度。在每个受试者中，我们识别出具有相同起始和初始传播模式但部分癫痫早期终止（截断性发作）而其他癫痫继续传播（持续性发作）的发作。我们首先比较了所有癫痫及截断-持续配对中癫痫的发作持续时间与ASM浓度。然后比较了匹配的截断性发作和持续性发作的持续时间。最后，我们比较了截断性发作和持续性发作发生时的ASM浓度。结果：发现较低ASM浓度下癫痫持续时间显著更长。持续性发作的持续时间显著长于匹配的截断性发作。我们发现截断性发作与持续性发作发生时的ASM浓度无显著差异。意义：截断性发作与持续性发作发生时ASM浓度的无差异表明，除早期停止传播途径外，存在缩短癫痫持续时间的独立机制。此外，导致癫痫截断的机制仍不清楚。需要进一步研究以理解ASM如何调节癫痫发作的持续时间和严重程度。
英文摘要：
Objective: Anti-seizure medications (ASMs) are the mainstay of treatment for epilepsy, yet their effect on seizure spread is not fully understood. Higher ASM doses have been associated with shorter and less severe seizures. We aimed to test if this effect was due to limiting seizure spread through early termination of otherwise unchanged seizures. Methods: We retrospectively examined intracranial EEG (iEEG) recordings in 15 subjects who underwent ASM tapering during pre-surgical monitoring. We estimated ASM plasma concentrations based on pharmaco-kinetic modeling. In each subject, we identified seizures that followed the same onset and initial spread patterns, but some seizures terminated early (truncated seizures), and other seizures continued to spread (continuing seizures). We first compared seizure duration to ASM concentration for all seizures and the subset of seizures included in truncated-continuing pairs. Then we compared durations of the matched truncated and continuing seizures. Finally, we compared ASM concentrations at the times of truncated seizures and continuing seizures. Results: Seizure durations were found to be significantly longer at lower ASM concentrations. Continuing seizures were significantly longer in duration than matched truncated seizures. We found no substantial difference between ASM concentrations when truncated vs. continuing seizures occurred. Significance: The lack of difference between ASM concentrations at the time of truncated vs. continuing seizures implies a separate mechanism for shortening the duration of seizures beyond stopping the spread pathways early. Additionally, the mechanism causing seizures to be truncated remains unclear. Further research is needed to understand how ASM may modulate seizure duration and severity.
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