title: The relationship between sleep and epilepsy: the effect on cognitive functioning in children.
abstract: OBJECTIVE
  The purpose of this review was to examine the possible pathophysiological links between epilepsy, cognition, sleep macro- and microstructure, and sleep disorders to highlight the contributions and interactions of sleep and epilepsy on cognitive functioning in children with epilepsy.
  
  
  METHODS
  PubMed was used as the medical database source. No language restriction was placed on the literature searches, and citations of relevant studies in the paediatric age range (0-18 y) were checked. Studies including a mixed population but with a high percentage of children were also considered.
  
  
  RESULTS
  The searches identified 223 studies. One reviewer scanned these to eliminate obviously irrelevant studies. Three reviewers scanned the remaining 128 studies and their relevant citations. The review showed that several factors could account for the learning impairment in children with epilepsy: aetiology, electroencephalographic (EEG) discharges, and persistence and circadian distribution of seizures, etc. EEG discharges may affect cognition and sleep, even in the absence of clinical or subclinical seizures. The sleep deprivation and/or sleep disruption affect the neurophysiological and neurochemical mechanisms important for the memory-learning process, but also influence the expression of EEG discharges and seizures. Learning and memory consolidation can take place over extended periods, and sleep has been demonstrated to play a fundamental role in these processes through neuroplastic remodelling of neural networks. Epilepsy and EEG paroxysms may affect sleep structure, interfering with these physiological functions.
  
  
  CONCLUSIONS
  Improvement in the long-term cognitive-behavioural prognosis of children with epilepsy requires both good sleep quality and good seizure control. The antiepileptic drug of choice should be the one that interferes least with sleep structure and has the best effect on sleep architecture--thus normalizing sleep instability, especially during non-rapid eye movement sleep.
authors.affiliation: Child Neurology and Sleep Paediatric Disorders Centre, II Faculty of Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy. pasquale.parisi@uniroma1.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Parisi
authors.forename: Oliviero
authors.initials: O
authors.lastname: Bruni
authors.forename: Maria
authors.initials: M
authors.lastname: Pia Villa
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
authors.forename: Silvia
authors.initials: S
authors.lastname: Miano
authors.forename: Anna
authors.initials: A
authors.lastname: Luchetti
authors.forename: Paolo
authors.initials: P
authors.lastname: Curatolo
mesh_terms: D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D002648:Child; D003071:Cognition / Q000187:drug effects / Q000502:physiology*; D004827:Epilepsy / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D012890:Sleep / Q000187:drug effects / Q000502:physiology*