This study showed that a high proportion of patients with medically intractable epilepsy from diffuse gliomas derive a significant and durable benefit from radiotherapy in terms of epilepsy control and that this positive effect is not strictly associated with tumor shrinkage as shown on MRI. Radiotherapy at tumor progression seems as effective as early radiotherapy after surgery. Prospective studies must confirm and better characterize the response to radiotherapy.

SUMMARYPurpose: To analyze the topography of the epileptogenic zone (EZ) and the etiologic substrate as risk factors for sleep-related focal epilepsy. Methods: Three hundred three patients (172 males and 131 females, mean age at surgery 25.6 ± 13.1 years), who were seizure-free after resective surgery for drug-resistant focal epilepsy, were retrospectively reviewed. Statistical analysis was conducted to evaluate the risk of presenting sleep-related epilepsy (SRE) against topography of resection (assumed to correspond or to include the EZ) and results of histology. Results: Thirty-nine patients (12.8% %) presented with an SRE. At bivariate analysis, a higher frequency of SRE was associated with a frontal lobe EZ (p = 1.94 · 10 )9 ) and Taylor's FCD (TFCD, p = 2.20 · 10 )16 ), whereas architectural FCD (p = 0.00977), ganglioglioma (p = 0.02508), and mesial temporal sclerosis (p = 2.47 · 10 )5) were correlated with a reduced frequency of SRE. Multivariate analysis demonstrated that the only variable significantly associated with SRE was the presence of a TFCD, which increased 14-fold the risk of SRE [p = 1.66 · 10 )10 ; risk ratio (RR) = 14.44]. Discussion: In this study, we have demonstrated a significant and strong association between SRE and TFCD in a select population of patients with drug-resistant focal epilepsy submitted to surgical resection of the EZ. Although our results cannot be applied to the entire spectrum of SRE, the presence of TFCD as the underlying etiology should be considered when evaluating patients with SRE, because surgery can provide excellent results on seizures in these cases.

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Summary:Purpose: Individuals with epilepsy commonly report daytime sleepiness, attributed to sleep disruption (frequent arousals, awakenings, and stage shifts) induced by ictal and interictal activity or antiepileptic drugs (AEDs) or both. To study the effect of levetiracetam (LEV) on sleep, at full doses but without the interference of epilepsy, we investigated the sleep architecture and daytime vigilance in healthy adults after 3 weeks of treatment.Methods: The study was of a double-blind crossover design with random allocation of multiple doses of two different treatments (randomly first LEV ≤2,000 mg/day or placebo for 3 weeks, washout for 4 weeks, and then the alternative treatment for another 3 weeks). Fourteen healthy volunteers were studied with polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). Epworth Sleepiness Scale (ESS) and sleep log also were evaluated.Results: After treatment with LEV, statistically significant increases were observed in total sleep time, sleep efficiency, and time spent in non-rapid eye movement (NREM) sleep stages 2 and 4. Stage shifts and wake after sleep onset were significantly decreased. Sleep latency was normal at PSG and MSLT in all subjects and did not statistically differ between placebo and LEV. No changes were found in the ESS.Conclusions: Our findings show that in healthy volunteers, LEV consolidates sleep and does not modify vigilance, two appreciated qualities in epilepsy patients with sleep disturbance and daytime sleepiness. Key Words: LevetiracetamSleep architecture-Daytime sleepiness-Antiepileptic drugsPolysomnography.Frequently patients with epilepsy complain of sleep disruption and report daytime sleepiness. Even if, in these patients, sleep may be disrupted also in the absence of seizures and antiepileptic drugs (AEDs), usually these symptoms are related to the effects of ictal and interictal activity or AEDs or both (1). Sleep and epilepsy have reciprocal effects, because sleep is a strong modulator of epileptic activity, which, in turn, can alter the sleep-wake cycle and sleep architecture. The resulting sleep deprivation may provoke further seizures (2). AEDs are able to modify the epileptic phenomena and the sleep architecture by acting at both levels (3). Older AEDs usually reduce the percentage of rapid eye movement (REM) sleep and slow wave sleep (SWS), increase fragmentation, and induce daytime sleepiness (4). The main difference between older and newer AEDs concerns mainly daytime sleepiness, more frequently associated with traditional AEDs (2), although newer AEDs are reported to be less disruptive to sleep (5).In mono-and polytherapy trials, levetiracetam (LEV) has been reported to cause somnolence in 4-15% of the patients, leading to drug discontinuation in 10% of patients (6). Bell et al. (7) evaluated the effects of LEV (1,000 mg in a single dose) on sleep in healthy volunteers and patients with epilepsy receiving carbamazepine (CBZ) monotherapy. LEV produced an increase in non-REM (NREM) sleep stage 2 both in volunteers and pati...