Sleep and Epilepsy.
Seizures and antiepileptic drugs (AEDs) affect sleep macroarchitecture and may produce excessive daytime sleepiness (EDS) in patients with epilepsy. Sleep is a potent activator of seizures and epileptiform discharges. In some patients, seizures occur exclusively or predominately in sleep. Benign focal epilepsy of childhood with centrotemporal spikes (BECTS), supplementary sensorimotor area epilepsy (SSMA) and Lennox Gastaut syndrome are a few of the more common epilepsy syndromes characterized by nocturnal seizures. Excessive daytime sleepiness is a common complaint of patients with epilepsy. Causes of EDS include seizures, AEDs, poor sleep hygiene, and coexisting sleep disorders. Pharmacologic therapy is aimed at identifying the single most effective drug for a given seizure type or epilepsy syndrome. Polytherapy is associated with a higher likelihood of adverse effects--most notably, EDS. Poor sleep hygiene leads to sleep fragmentation that can exacerbate seizures and EDS. Primary sleep disorders should be suspected in patients with EDS, particularly those treated with monotherapy at low serum drug concentrations and well controlled seizures. Treatment of sleep disorders may lead to better seizure control.
Foldvary
Nancy
N
Department of Neurology, Section of Epilepsy and Sleep Disorders, The Cleveland Clinic Foundation, 9500 Euclid Avenue, S-51, Cleveland, OH 44195, USA. foldvan@ccf.org