rTMS Improves Cognition in Patients With Self-Limited Epilepsy With Centrotemporal Spikes With Electrical Status Epilepticus in Sleep via Increase of the Sleep Spindle

IF 5 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-07-07 DOI:10.1111/cns.70501

Yixian Han, Jing Gao, Yongkang Zhou, Jiahui Deng, Huajun Yang, Xiongfei Wang, Jing Wang, Yujiao Yang, Jie Ren, Lingling Chen, Minghui Wang, Qinqin Deng, Haidan Wang, Mengyang Wang, Tianfu Li

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Abstract

Background

Patients with self-limited epilepsy with centrotemporal spikes (SeLECTS) and electrical status epilepticus in sleep (ESES) lead to cognitive impairment. However, therapeutic options are limited.

Objectives

The sleep spindle is a biomarker of cognitive dysfunction in patients with SeLECTS. This study aimed to explore whether the sleep spindle is linked to the outcome of repetitive transcranial magnetic stimulation (rTMS) in patients with SeLECTS with ESES.

Methods

Nine patients with SeLECTS with ESES underwent low-frequency rTMS (≤ 1 Hz) or continuous theta burst stimulation (cTBS) for 10 days. To assess the clinical efficacy and alteration in the sleep spindle, EEG recordings were performed both before and after rTMS. A machine learning algorithm YASA was used to calculate the coupling of the sleep spindle and slow waves.

Results

75% of patients remained seizure-free for 6 months after rTMS. The spike–wave index (SWI) decreased significantly after rTMS compared with the baseline. The sleep spindle significantly increased in all patients at 3 months and 6 months after rTMS (p = 0.002). Both IQ and MQ improved significantly at 6 months after rTMS. Improvement of IQ and increase of the sleep spindle was significantly positively correlated (p = 0.035). The mean probability of the sleep spindle coupling in the slow wave “up” state increased from 28% to 55%.

Conclusion(s)

Increase of the sleep spindle and the mean probability of the sleep spindle coupling in the slow wave “up” state might be a potential mechanism for cognition improvement in patients with SeLECTS with ESES.

Abstract Image

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rTMS通过增加睡眠纺锤波改善睡眠中癫痫持续电状态伴有中央颞叶尖峰的自限性癫痫患者的认知

背景：伴有中央颞叶尖峰（SeLECTS）和睡眠中癫痫持续电状态（ESES）的自限性癫痫患者可导致认知障碍。然而，治疗选择是有限的。目的：睡眠纺锤体是select患者认知功能障碍的生物标志物。本研究旨在探讨睡眠纺锤体是否与选择性睡眠伴ESES患者重复经颅磁刺激（rTMS）的结果有关。方法9例select合并ESES患者分别采用低频rTMS（≤1hz）或连续θ波爆发刺激（cTBS）治疗10 d。为了评估临床疗效和睡眠纺锤体的改变，在rTMS前后分别进行脑电图记录。采用机器学习算法YASA计算睡眠纺锤波与慢波的耦合。结果75%的患者在rTMS后6个月内无癫痫发作。与基线相比，rTMS后的峰值波指数（SWI）明显下降。在rTMS后3个月和6个月，所有患者的睡眠纺锤体均显著增加（p = 0.002）。在rTMS后6个月，智商和MQ均有显著提高。智商的提高与睡眠纺锤体的增加呈显著正相关（p = 0.035）。慢波“上”状态下睡眠纺锤体耦合的平均概率从28%增加到55%。结论(5)睡眠纺锤波的增加和睡眠纺锤波在慢波“上”状态耦合的平均概率可能是select合并ESES患者认知改善的潜在机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.