title: Interictal spiking increases with sleep depth in temporal lobe epilepsy.
abstract: OBJECTIVE
  To test the hypothesis that deepening sleep activates focal interictal epileptiform discharges (IEDs), we performed EEG-polysomnography in 21 subjects with medically refractory temporal lobe epilepsy.
  
  
  METHODS
  At the time of study, subjects were seizure-free for > or =24 h and were taking stable doses of antiepileptic medications (AEDs). Sleep depth was measured by log delta power (LDP). Visual sleep scoring and visual detection of IEDs also were performed. Logistic-regression analyses of IED occurrence in relation to LDP were carried out for two groups of subjects, nine with frequent IEDs (group 1) and 12 with rare IEDs (group 2).
  
  
  RESULTS
  The LDP differentiated visually scored non-rapid eye movement (NREM) sleep stages (p = 0.0001). The IEDs were most frequent in NREM stages 3/4 and least frequent in REM sleep. Within NREM sleep, in both groups, IEDs were more frequent at higher levels of LDP (p < 0.05). In group 1, after accounting for the level of LDP, IEDs were more frequent (a) on the ascending limb of LDP and with more rapid increases in LDP (p = 0.007), (b) in NREM than in REM sleep (p = 0.002), and (c) closer to sleep onset (p < 0.0001). Fewer than 1% of IEDs occurred within 10 s of an EEG arousal.
  
  
  CONCLUSIONS
  Processes underlying the deepening of NREM sleep, including progressive hyperpolarization in thalamocortical projection neurons, may contribute to IED activation in partial epilepsy. Time from sleep onset and NREM versus REM sleep also influence IED occurrence.
authors.affiliation: Department of Neurology, University of Michigan Medical School, Ann Arbor, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Malow
authors.forename: X
authors.initials: X
authors.lastname: Lin
authors.forename: R
authors.initials: R
authors.lastname: Kushwaha
authors.forename: M S
authors.initials: MS
authors.lastname: Aldrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000513:Alpha Rhythm / Q000706:statistics & numerical data; D003700:Delta Rhythm / Q000706:statistics & numerical data; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012044:Regression Analysis; D012890:Sleep / Q000502:physiology*; D012894:Sleep Stages / Q000502:physiology