The value of rapid eye movement sleep in the localization of epileptogenic foci for patients with focal epilepsy.

Purpose: Our aim was to investigate the value of rapid eye movement (REM) during prolonged scalp video-electroencephalography (VEEG) in the localization of epileptogenic foci for patients with focal epilepsy.Method: We retrospectively studied a total of 59 patients with focal epilepsy and 31 of 59 received surgery. We assessed localization of interictal epileptiform discharges (IEDs) during REM, non-rapid eye movement sleep (NREM) and wakefulness to compare with the localization of ictal EEG, clinical semiology, magnetic resonance imaging (MRI) and positron emission tomography (PET) and stereo-electroencephalogram (SEEG). We graded postoperative follow-up outcome according to Engel criteria to further verify the accuracy of localization of epileptogenic foci in REM-IEDs. NREM-IEDs and Wakefulness-IEDs. Stepwise multiple logistic regression was carried out to assess for independent association of good prognosis with REM accurate localization, temporal lobe epilepsy and MRI accurate localization.Results: Clinical semiology was concordant to REM-IEDs in 40 patients (72.7 %), NREM-IEDs in 27 (49.1 %), and Wakefulness-IEDs in 25 (45.5 %). MRI lesion was concordant with REM-IEDs in 35 patients (81.4 %), Wakefulness-IEDs in 26 (60.5 %), and NREM-IEDs in 25 (58.1 %). PET localization was concordant with REM-IEDs in 20 patients (76.9 %), Wakefulness-IEDs and NREM-IEDs in 11 (42.3 %). SEEG localization was concordant with REM-IEDs in 15 patients (65.2 %), Wakefulness-IEDs in 10 (43.5 %), and NREM-IEDs in 8 (34.8 %). Thirty-one patients received surgery, and 30 (96.8 %) of them achieved good seizure control (Engel I-III). The surgical site was concordant with REM-IEDs in 23 (74.2 %), Wakefulness-IEDs and NREM-IEDs in 14 (45.2 %). In addition, the accuracy of REM-IEDs localization in temporal epilepsy (90 %) was higher than that extra-temporal epilepsy (45.5 %). REM accurate localization of epileptogenic foci was an independent factor contributing to good prognosis (P = 0.025, OR = 12.368).Conclusions: Compared with NREM-IEDs and Wakefulness-IEDs, REM-IEDs had most value for localization of epileptogenic foci in patients with focal epilepsy. REM-IEDs- accurate localization of epileptogenic foci was an independent factor contributing to good prognosis for postsurgical patients with focal epilepsy. [ABSTRACT FROM AUTHOR]

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