0101 Effect of Anti-Seizure Medication on Spindle–Slow Oscillation Coupling in Childhood Absence Epilepsy: A Longitudinal Analysis

Abstract Introduction Spindle–slow oscillation (SP-SO) coupling supports memory via hippocampal–cortical communication. Childhood absence epilepsy (CAE), with 3-Hz spike-and-wave (SSW) discharges reflecting abnormal thalamocortical oscillations, is associated with cognitive deficits. Anti-seizure medications (ASM) may also alter SP-SO coupling; thus, evaluating ASM effects while adjusting for SSW is important. This study examined ASM’s impact on SP-SO coupling in children with CAE. Methods Authors retrospectively reviewed the medical records of patients who were diagnosed with CAE at one university hospital. Average montage sleep EEGs were analyzed using only stage N2. We calculated the z score for magnitude of SP-SO coupling (COUPL_MAG_Z) based on surrogate time series for 13Hz sleep spindle (SP) on C3 and 11Hz SP on F3 using the lunapi (https://zzz.bwh.harvard.edu/luna/). The generalized estimating equations (GEE) were then applied to evaluate the effects of ASM while adjusting for SSW, and conversely, to evaluate the effects of SSW while adjusting for ASM. Results This study enrolled 14 patients for the analysis. The positive SSW group had 11 subjects (mean age 8.3 ± 2.2 year-old) in the negative SSW group had 3 patients (mean age 7.9 ± 0.5 year old). A total of 7 patient was treated with ASM and most common ASM was lamotrigine. On GEE, ASM was associated with a significant increase in 11 Hz SP density on F3 (P < 0.01) after adjusting for SSW. Conversely, after adjusting for ASM, the negative SSW group exhibited higher 13 Hz SP density on C3 compared to the positive SSW group (P < 0.01). Additionally, after controlling for SSW, ASM was found to significantly reduce COUPL_MAG_Z at 11 Hz on F3 (P = 0.02) and at 13 Hz on C3 (P < 0.01). Conclusion Even after adjusting for SSW, ASM was associated with reduced slow SP-SO coupling in the frontal region and reduced fast SP-SO coupling in the central region. Prospective multimodal studies are needed to clarify the relationship between these biomarkers and cognitive function. Support (if any) A grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number : RS-2023-00267049)