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Sleep-Related Epilepsy

Current Treatment Options in Neurology volume 18, Article number: 23 (2016) Cite this article

Opinion statement

Sleep has a strong influence on interictal epileptiform discharges and on epileptic seizures. Interictal epileptiform discharges are activated by sleep deprivation and sleep, and some epilepsies occur almost exclusively during sleep. Treatment of sleep-related epilepsy should take in account the type of epileptic syndrome, the type of seizures, the patient characteristics, and also the pharmacokinetics of the drug. Proper characterization of the epilepsy is essential to choose appropriate antiepileptic drugs. Drugs effective in focal epilepsy may be used to treat benign genetic focal epilepsies such as rolandic epilepsy and other focal (frontal or not) sleep epilepsies. These include both classical (such as carbamazepine) and new (such as levetiracetam and lacosamide) antiepileptic drugs. Drug-resistant cases should be evaluated for epilepsy surgery, which may be efficacious in this setting. Valproate, lamotrigine, topiramate, levetiracetam, and perampanel are effective against generalized tonic-clonic seizures in genetic generalized epilepsies, which frequently happen on awakening. Risks of valproate should be considered before prescribing it to women of childbearing age. Specific syndromes such as ESES require specific treatment such as a combination of high dose steroids, benzodiazepines, levetiracetam, and even surgery when an epileptogenic lesion is present. Sleep disorders that may worsen epilepsy such as obstructive sleep apnea or insomnia should be adequately treated to improve seizure frequency. Adequate control of seizures during sleep (especially generalized tonic-clonic seizures) decreases risk of sudden unexpected death in epilepsy (SUDEP).

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Affiliations

  1. Epilepsy Unit, Hospital Clínic, C/Villarroel, 170. 08036, Barcelona, Spain

    Mar Carreño MD, PhD

  2. Department of Neurology, Hospital Platón, Barcelona, Spain

    Santiago Fernández MD

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  1. Mar Carreño MD, PhD
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  2. Santiago Fernández MD
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Correspondence to Mar Carreño MD, PhD.

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Santiago Fernández declares no conflict of interest.

Mar Carreño reports grants and personal fees from UCB Pharma and Eisai and personal fees from Esteve and Bial Pharmaceutical.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Sleep Disorders

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Carreño, M., Fernández, S. Sleep-Related Epilepsy. Curr Treat Options Neurol 18, 23 (2016). https://doi.org/10.1007/s11940-016-0402-9

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Keywords

  • Epilepsy
  • Sleep
  • Obstructive sleep apnea
  • Nocturnal
  • Awakening
  • Treatment