Impact of sleep on epileptic manifestations

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By Liborio Parrino MD

The circadian, homeostatic, ultradian, and microstructural processes that regulate the sleep-wake cycle are endowed with modulatory properties on epileptic events. In particular, sleep is a powerful trigger of both ictal and interictal manifestations. Non-REM sleep and cyclic alternating pattern promote strong activating effects, although REM sleep tends to exert a more inhibitory action. These characteristics are highly expressed in nocturnal frontal lobe epilepsy.

Key Points

  • Sleep is a powerful enhancer of epileptic features.
  • Synchronized non-REM sleep facilitates seizures, whereas desynchronized REM sleep dampens seizure occurrence.
  • The presence of nocturnal seizures affects the regular profile of the sleep architecture.
  • Marked sleep instability, as expressed by cyclic alternating pattern (CAP), is often observed in epileptic patients, even in the absence of nocturnal seizures.
  • Sleep-related seizures mostly affect conventional sleep measures, whereas nocturnal interictal discharges basically have a destabilizing impact on CAP parameters.