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July2005 Vol.42 Issue:        2        Table of Contents
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The Relationship between Sleep and Epilepsy (A Clinical and Neurophysiological Study)

H. Elwan1, M. El-Tamawy1, S. Salem2, Mona T. El-Ghoneimy3
Departments of Neurology1, Neurophysiology2, Neurosurgery3,Cairo University

ABSTRACT

A reciprocal relationship is observed between sleep and epilepsy. The sleep effect on epilepsy is both protective and facilitating. On the other hand, epilepsy causes alteration of sleep organization. The aim of this work was to highlight the sleep pattern in patients with idiopathic generalized and complex partial epilepsy, to detect the effect of antiepileptic drugs (AEDs) on sleep macrostructure, and to observe sleep influence on epileptic activity. To achieve this aim we selected 30 untreated adult epileptic patients: 15 with temporal lobe epilepsy (TLE) and 15 with generalized tonic clonic seizures (GTCS), and reassessed them after three months of carbamazepine (CBZ) and sodium valproate (VPA) monotherapy respectively. Ten control subjects were also included. Subjects underwent clinical assessment, magnetic resonance imaging (MRI) for brain (for patients), conventional daytime electroencephalograrm (EEG) recording, assessment of sleep architecture as well as sleep interictal discharge (IID) using  video-polysomnographic recording, and assessment of daytime sleepiness using Epworth sleep scale (ESS). Results showed that untreated epileptic patients with TLE experienced more sleep abnormalities compared to controls, more sleep abnormalties were observed in patients with TLE compared to those with GTCS but this difference was not statistically significant. No statistically significant difference was found between patients with TLE and those with GTCS as regards sleep parameters before or after treatment. CBZ and VPA monotherapy have restorative and normalizing effects on sleep pattern, non-rapid eye movement (NREM) sleep has a facilitating effect on IID especially lighter stages (stage I and II), while rapid eye movement (REM) sleep has anti-epileptogenic effect. Untreated epileptic patients had significant excessive daytime sleepiness compared to controls, chronic CBZ and VPA monotherapy improve subjective daytime sleepiness, and that sleep EEG monitoring is more sensitive than daytime EEG recording.

(Egypt J. Neurol. Psychiat. Neurosurg., 2005, 42(2): 311-322).





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