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Sleep, Circadian Rhythms, and Epilepsy

  • Epilepsy (E Waterhouse, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

There is a known interrelationship between sleep and epilepsy. This review highlights the recent findings regarding interactions between sleep and circadian rhythms and the manifestations of epilepsy and surgical treatments for refractory epilepsy.

Recent findings

CLOCK gene expression may be reduced within the epileptogenic focus in patients with refractory epilepsy. Interictal epileptiform discharges during NREM and especially REM sleep may lateralize to the epileptogenic hemisphere. Intracranial video EEG monitoring and EEG from implanted responsive neurostimulator devices confirm scalp video EEG findings of a nocturnal peak for interictal epileptiform discharges. Successful epilepsy surgery may improve sleep macrostructure and quality.

Summary

Sleep outcomes in people with epilepsy undergoing epilepsy surgery and neurostimulator implantation may provide innovative understandings into the associations between sleep and epilepsy. These associations may then provide novel therapeutic options targeting sleep and circadian pathways to improve seizure control and improve the quality of life for patients with this debilitating disorder.

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Abbreviations

ANT:

Anterior nucleus of the thalamus

DBS:

Deep brain stimulation

IED:

Interictal epileptiform discharges

NREM:

Non-rapid eye movement sleep

N1:

NREM stage 1 sleep

N2:

NREM stage 2 sleep

N3:

NREM stage 3 sleep or slow wave sleep

RNS:

Responsive neurostimulation

VNS:

Vagus nerve stimulation

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, 1719 6th Avenue South, 312 CIRC, Birmingham, AL, 35294, USA

    Joseph T. Daley MD, PhD & Jennifer L. DeWolfe DO

  2. BVAMC Neurology Sleep Service, Birmingham VA Medical Center, 700 South 19th Street, Birmingham, AL, 35233, USA

    Joseph T. Daley MD, PhD & Jennifer L. DeWolfe DO

Authors
  1. Joseph T. Daley MD, PhD
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  2. Jennifer L. DeWolfe DO
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Corresponding author

Correspondence to Jennifer L. DeWolfe DO.

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Conflict of Interest

Joseph T. Daley reports no conflicts of interest. Jennifer L. DeWolfe reports grants from Marinus Pharmaceuticals, outside the submitted work.

Human and Animal Rights and Informed Consent

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

Additional information

Take-home points

• Interictal epileptiform discharges have a nocturnal peak in focal and generalized epilepsies

• Interictal epileptiform discharges during REM sleep may help lateralize the hemisphere containing the seizure onset zone in people with intractable epilepsy

• CLOCK gene expression may be reduced within the epileptogenic focus in patients with refractory epilepsy

• Lower intensity settings on Vagus nerve stimulators may improve daytime sleepiness and vigilance in people with refractory epilepsy while higher intensity settings and rapid cycling may increase risk of sleep apnea

• Sleep architecture, daytime sleepiness, and sleep quality may be improved in patients who become seizure free following focal cortical resection

This article is part of the Topical Collection on Epilepsy

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Daley, J.T., DeWolfe, J.L. Sleep, Circadian Rhythms, and Epilepsy. Curr Treat Options Neurol 20, 47 (2018). https://doi.org/10.1007/s11940-018-0534-1

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