title: Do seizures in patients with refractory epilepsy vary between wakefulness and sleep?
abstract: OBJECTIVE
  To determine the effects of sleep and wakefulness on seizures in patients with refractory epilepsy recorded while undergoing video-electroencephalography (EEG) telemetry.
  
  
  METHODS
  The video-EEG data of patients who had two or more seizures during video-EEG telemetry (n = 270) were reviewed. Fifty seven patients who had seizures both in wakefulness and sleep were identified. The video and ictal EEG data were reviewed, paying specific attention to type of seizures, duration, semiology, lateralisation and number of seizures.
  
  
  RESULTS
  Three hundred and sixty two seizures were recorded; 237 seizures while awake and 125 while sleeping. Secondary generalisation occurred more often in sleep than in wakefulness (p < 0.01). Overall, there was no significant effect of sleep on the duration of seizures or ictal EEG change. Sleep and awake seizures differed in only eight patients.
  
  
  CONCLUSIONS
  Secondary generalisation occurred more often in sleep than in wakefulness, perhaps due to the facilitated spread of seizures during sleep. For the most part, however, seizures recorded during sleep did not differ from those recorded during wakefulness.
authors.affiliation: Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: M
authors.initials: M
authors.lastname: Brady
authors.forename: C A
authors.initials: CA
authors.lastname: Scott
authors.forename: M C
authors.initials: MC
authors.lastname: Walker
mesh_terms: D004351:Drug Resistance; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000503:physiopathology*; D012895:Sleep, REM / Q000502:physiology*; D014741:Video Recording; D014851:Wakefulness / Q000502:physiology*