Bial, Eisai, GlaxoSmithKline, Janssen-Cilag, Novartis, Pfizer, Sanofi-Aventis, UCB, the Netherlands Epilepsy Foundation, and Stockholm County Council.

The objective of this study was to assess the effect of phasic rapid eye movement (REM) sleep events on interictal epileptiform discharges (IEDs). Twelve patients with focal epilepsy and IEDs during REM sleep were examined by video-EEG monitoring. The number of IEDs was calculated in different REM sleep episodes according to the rate of rapid eye movements. A negative correlation was identified between the occurrence of rapid eye movements and IEDs, indicating that the suppression of propagation of IEDs during REM sleep is enhanced by phasic REM sleep events, probably as a result of phasic activation of cholinergic neurons of the ponto-mesencephalic tegmentum. This study demonstrates that the degree of EEG desynchronization and IEDs is influenced by REM density.

In order to evaluate the influence of the respiratory cycle on the EEG, we compared the power spectral analysis of the EEG performed by fast Fourier transformation during inspirium and exspirium in 10 healthy subjects. The measurement was performed during spontaneous breathing and then during eupnoe (0.25 Hz), bradypnoe (0.1 Hz) and tachypnoe (0.5 Hz) paced by a metronome. In the course of spontaneous breathing and bradypnoe, there was an increase in the delta power and in the total power in the anterior temporal region during inspirium in comparison with exspirium. The eupnoe was characterized by an inspiratory decrease in the delta power in the parietal region and in the total power in the frontal region. The tachypnoe resulted in a decrease of the beta power in the central region and a decrease of the theta power in the posterior temporal and in the occipital region during inspirium. In comparison of the EEG in eupnoe, bradypnoe and tachypnoe, a decrease of spectral power of all spectral bands was found except for delta during faster breathing frequencies and vice versa with a significant difference which was found mostly between bradypnoe and tachypnoe, less frequently between eupnoe and tachypnoe.

We conclude that long-term use of modafinil does not influence the cardiac autonomic reactivity to orthostatic load expressed by the HRV changes in supine-standing-supine test in narcolepsy type 1 patients, but the parasympathetic cardiac activity may be reduced in quiet supine position in patients with narcolepsy taking modafinil.

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