Sleep disorder is one of the prominent manifestations of Angelman syndrome. The exact causes are unknown and methods of correction are difficult. The literature review is devoted to studies of the pathogenesis of sleep disorders in Angelman syndrome (the effects of gene function in 15q11–q13 deletion, findings in polysomnography, video-EEG sleep monitoring, laboratory data), on the basis of which recommendations for the correction of dyssomnia, including methods of behavioral therapy, are given.

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Introduction. Cerebral palsy is often combined with epilepsy and epileptiform electroencephalographic (EEG) activity. Currently, the question of how rehabilitation with cerebral palsy is dangerous in relation to the provocation of epileptic seizures is relevant. Objective: to study the effect of cerebral palsy rehabilitation on epilepsy in a standard rehabilitation center. Material and methods. We examined 80 children with various forms of cerebral palsy and epileptiform EEG activity. The patients were divided into two groups: children of Group 1 never had epileptic seizures, children of Group 2 had a history of epileptic seizures of more than 6 months ago. The follow-up was 12 months during which children underwent EEG before and after rehabilitation courses. Depending on the risks associated with provoking epileptic seizures, patients were prescribed rehabilitation procedures of various intensities: Vojta kinesiotherapy, massage, physiotherapeutic treatment in the form of transcranial micropolarization and paraffin therapy. Results. During the study, epileptic seizures developed in 5 patients (12.5%) from Group 1 and in 7 children (17.5%) from Group 2. In all cases, rare focal seizures were recorded (1–2 times a year). All patients with seizures during our study had a history of seizures under the age of 1 year. The onset of seizures was quickly stopped by the basic antiepileptic drugs in monotherapy. Epileptic seizures developed in children with moderate to severe cerebral palsy on GMFCS (Gross Motor Function Classification System) and a history of neonatal seizures. We attributed both of these to risk factors. In children with cerebral palsy and epilepsy in remission of 6 months or more, massage and Vojta therapy did not provoke epileptic seizures. The effect of epileptiform activity on the severity of motor status and on cognitive functions in cerebral palsy has not been established in our study. Conclusion. According to our data, rehabilitation measures do not have a significant impact on the risk of developing epilepsy.

Aim. To assess the efficacy and tolerability of lamotrigine (Sazar) for various forms of epilepsy, based on long-term experience of Svt. Luka's Association of Medical Institutions for the Diagnosis, Treatment, and Rehabilitation of Nervous System Diseases and Epilepsy. We analyzed the data obtained during 4 years (from June 2018 to August 2022).Materials and methods. We evaluated the efficacy and tolerability of Sazar in 104 patients aged 3 to 37 years (87 children and 17 adults (12 women and 5 men)); their mean age was 9.7 years. The sample included 42 males and 62 females. All of them were treated at Svt. Luka's Association of Medical Institutions for the Diagnosis, Treatment, and Rehabilitation of Nervous System Diseases and Epilepsy.The sample included patients with structural and presumably structural focal epilepsy (n = 44), focal epilepsy of unknown etiology (n = 6), genetic and presumably genetic epilepsy and epileptic encephalopathies (n = 43), idiopathic epilepsy (n = 11).Sazar was used as a monotherapy in 38 patients, whereas 66 patients received it in combination with other antiepileptic drugs (AED) (Sazar + 1 AED in 48 patients; Sazar + 2 AED in 18 patients). Two patients initially receiving polytherapy were successfully transferred to Sazar monotherapy.The dose of Sazar varied between 75 and 400 mg/day. In the majority of patients, including all children, Sazar daily dose was split into 2 portions. Three adult patients received Cazar once a day either in the evening (n = 2) or in the morning (n = 1) at a dose of 200 mg/day. The follow-up time was between 6 months and over 4 years.Results and conclusion. Therapeutic remission was achieved in 47 out of 104 patients (45.2 %) receiving Sazar. As many as 35 patients (33.6 %) demonstrated an at least 50 % reduction in seizure frequency; 22 patients had no effect (21.2 %). None of the participants developed significant aggravation.Only 9 patients (8.6 %) discontinued Caser due to its initial low efficacy, while another 8 patients (7.6 %) stopped to receive Casar because it became ineffective after 6–12 months of treatment. In general, good therapeutic effect (remission or at least 50 % reduction in seizure frequency) was achieved in 82 out of 104 patients (78.8 %). Given the fact that this study included patients with severe epilepsy, we can conclude that treatment was very effective.Casar was most effective in patients with focal epilepsy (including structural, presumably structural, structural-genetic, and that of unidentified etiology) and idiopathic generalized epilepsy.The majority of the patients (n = 94; 90.4 %) demonstrated good tolerability of Casar. Casar-associated side effects were registered in 10 patients (9.6 %). Allergic skin rash was observed in 5 cases (4.8 %) and developed during the first 2 months of therapy. Allergic reactions accounted for 50 % of all side effects and were the only reason for Casar discontinuation due to poor tolerability.Two female patients of reproductive age started Sazar to reduce the valproate dose that caused severe menstrual disorders, weight gain, alopecia, and edema. Halving the dose of valproate (up to 750 mg/day) in combination with Casar significantly improved treatment tolerance. One patient gave birth to a healthy baby when she was receiving monotherapy with Sazar at a dose of 350 mg/day.Eight patients receiving Sazar reported a significant improvement in their mood and behavior (one patient that had earlier been diagnosed with depression discontinued antidepressants after Sazar initiation since she did not need them any longer). None of the patients reported any negative effects of Sazar on their memory, attention, mood, and behavior (as evaluated by patients and parents; in some cases, by a neuropsychologist).Patients’ adherence to treatment confirmed high Sazar efficacy and tolerability: 82 out of 104 patients (78.8 %) continued to receive the drug after 6 months of treatment and 69 patients (66.3 %) still continued it after 12 months of treatment. The follow-up period varied between 6 months and 4 years.Thus, our findings suggest high efficacy and good tolerability of long-term therapy with Sazar in patients with different forms of epilepsy.

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