title: Risk of seizures while awake in pure sleep epilepsies: a prospective study.
abstract: OBJECTIVE
  To estimate the risk of seizures while awake in pure sleep epilepsies in a prospective study.
  
  
  METHODS
  From October 1, 1992, to October 31, 1996, all patients with pure sleep epilepsy presenting at a participating center were enrolled. Children with benign rolandic epilepsy and patients with frontal lobe epilepsy were excluded. Patients were followed for at least 2 up to 6 years. The primary endpoint was the occurrence of a seizure while awake.
  
  
  RESULTS
  The authors enrolled 161 patients (64% male). Age at the time of inclusion ranged from 11 to 83 years (mean 43.2, median 39). Eighty-five percent presented generalized tonic clonic seizures. Both sleep seizures and seizures while awake were absent for 2 years after inclusion in the study in 78% of patients. Eighteen patients presented a seizure while awake. The estimated risk of a seizure while awake during 6 years of follow-up was 13% (95% CI 7 to 18%). Multivariate analysis showed that episodes of sudden withdrawal of therapy and a higher frequency of seizures at inclusion were associated with an increased risk of seizures while awake. The estimated risk of a seizure while awake in patients with none of the above risk factors was 6.5% (95% CI 1.5 to 11.3%) during 6 years of follow-up.
  
  
  CONCLUSIONS
  The clinical picture of pure sleep epilepsies is characterized by a preponderance of generalized tonic clonic seizures, low seizure frequency, and a good prognosis. The risk of occurrence of a seizure while awake is low, particularly among patients with rare seizures and good compliance with the therapy.
authors.affiliation: Neuroepidemiology Unit, Department of Neurological Sciences, University of Bologna, Italy. daless.rob@iol.it
authors.forename: Roberto
authors.initials: R
authors.lastname: D'Alessandro
authors.forename: Maria
authors.initials: M
authors.lastname: Guarino
authors.forename: Gabriele
authors.initials: G
authors.lastname: Greco
authors.forename: Leona
authors.initials: L
authors.lastname: Bassein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications*; D004830:Epilepsy, Tonic-Clonic / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology; D020919:Sleep Disorders, Intrinsic / Q000150:complications*; D014851:Wakefulness