Application Of Cerebral Blood Perfusion Analysis Based On 3D-pCASL In Patients With Sleep Disorders Comorbid With Idiopathic Generalized Epilepsy With Generalized Tonic-colonic Seizure

Objective To analyze the influencing factors of sleep disorders comorbid with idiopathic generalized epilepsy with generalized tonic-colonic seizure(IGE-GTCS);To study the cerebral perfusion characteristics of patients with IGE-GTCS comorbid sleep disorders and IGE-GTCS patients.Methods Sixty-two patients who attended the epilepsy clinic of the Department of Neurology,General Hospital of Ningxia Medical University from December 2021 to December 2022 and were diagnosed with IGE-GTCS were collected,general demographic information and clinical data were collected,and the Pittsburgh Sleep Quality Index Scale,Insomnia Severity Index Scale,Sleepiness Scale,Simple Intelligence Scale,and Anxiety and Depression Self-Rating Scale were refined.Patients with complaints of sleep disorders,Pittsburgh Sleep Quality Index score >7 and meeting the diagnostic criteria of the International Classification of Sleep Disorders,3rd edition,were included in the IGE-GTCS co-morbid sleep disorder group;Patients without complaints of sleep disturbance and with a Pittsburgh Sleep Quality Index score ≤7 were included in the IGE-GTCS group.In addition,16 patients matching the age,gender and education level of the case group,who received craniocerebral CT or magnetic resonance examination and other patients without neurological diseases were included in the control group.All patients underwent three dimensional-pseudo continuous arterial spin labeling(3D-p CASL)imaging examination.Statistical analysis of age, age of onset,gender,education,duration of illness,and whether the EEG was abnormal in the IGE-GTCS comorbid sleep disorder group and the IGE-GTCS group,and independent risk factors for IGE-GTCS comorbid sleep disorder using univariate and multifactorial logistic regression analysis.The ASL raw images were post-processed by GE ADW4.7READYVIEW workstation software package,and the regions of interest(ROI)were selected from the bilateral frontal,temporal,parietal,occipital,insula,cerebellum,hippocampus,thalamus,amygdala,caudate nucleus and Bean-like nucleus,and the cerebral blood flow(CBF)was measured,and further statistical analysis.To investigate the changes in cerebral blood perfusion in patients with IGE-GTCS co-morbid sleep disorders and in patients with IGE-GTCS.The CBF of brain regions in the three groups of subjects were compared and the brain regions with differences(P<0.05,statistically significant)were identified.Results 1.There were 13 patients in the IGE-GTCS comorbid sleep disorder group and 49 patients in the IGE-GTCS group in this study.Univariate analysis showed that there were no statistically significant differences between the IGE-GTCS comorbid sleep disorder group and the IGE-GTCS group in age,sex,age of onset,education,duration of illness,presence or absence of EEG abnormalities,frequency of episodes in the last 6 months,tendency to have nocturnal episodes,number of medication types,type of medication,total MMSE score and total SDS score,and statistically significant differences in age of onset(P=0.023),anxiety status(P=0.018),Multifactor regression analysis showed that anxiety state(P=0.030)was an independent risk factor for IGE-GTCS comorbidity of sleep disorders.2.In this study,there were 13 patients in the IGE-GTCS comorbid sleep disorder group,49 patients in the IGE-GTCS group,and 16 patients in the control group.The brain regions with statistically significant differences in CBF between the IGE-GTCS comorbid sleep disorder group,the IGE-GTCS group and the control group were the left frontal lobe,the left thalamus and the left hippocampus.A two-by-two comparison showed that CBF was significantly reduced in the left frontal lobe and left thalamus in the IGE-GTCS comorbid sleep disorder group and the IGE-GTCS group compared to the control group(p<0.05).CBF was significantly reduced in the left hippocampus in the IGE-GTCS comorbid sleep disorder group compared with the IGE-GTCS group and the control group(P<0.05).3.There were 62 patients with IGE-GTCS,13 in the IGE-GTCS comorbid sleep disorder group,8(8/13,62%)had abnormal ASL perfusion,and 7(7/13,54%)showed epileptiform discharges on EEG.In the IGE-GTCS group of 49 cases,30(30/49,61%)had abnormal perfusion in ASL and 33(33/49,67%)had epileptiform discharges in EEG.The positive rate of dynamic or video EEG was 65%,the detection rate of ASL was 61%,and the percentage of brain areas showing abnormal perfusion in ASL that were partially identical to the extent of EEG showing epileptiform discharges was 16%.Conclusion 1.Anxiety state is the risk factor for IGE-GTCS comorbidity of sleep disorders.2.Cerebral perfusion was generally reduced in IGE-GTCS patients,mainly in the left frontal lobe and left thalamus;cerebral perfusion in the left hippocampus was significantly reduced in IGE-GTCS patients with comorbid sleep disorders.3.In patients with IGE-GTCS,there was no significant correlation between the brain region with abnormal cerebral blood flow perfusion and the site of epileptic discharge indicated by EEG.