Effects of antiepileptic drugs on sleep architecture parameters in adults

Carvalho, Bruno Miguel Santos; Chaves, João; Silva, António Martins da

doi:10.5935/1984-0063.20220045

Cited by 11 publications

(5 citation statements)

References 95 publications

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“…In addition, cognitive function and QoL were not negatively impacted following perampanel monotherapy or first adjunctive therapy. These findings are supported by previous evidence that suggests perampanel can have a positive effect on sleep quality [ 30 , 31 ].…”

Section: Discussionsupporting

confidence: 89%

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Perampanel as monotherapy or first adjunctive therapy in pediatric and adult patients with epilepsy: the first United States-based phase IV open-label ELEVATE study

Punia,

Klein,

Mihaylova

et al. 2024

J Neurol

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ELEVATE (Study 410; NCT03288129) is the first prospective, multicenter, open-label, Phase IV study of perampanel as monotherapy or first adjunctive therapy in patients aged ≥ 4 years with focal-onset seizures or generalized tonic–clonic seizures in the United States. The study included Screening, Titration (≤ 13 weeks), Maintenance (39 weeks), and Follow-up (4 weeks) Periods. During Titration, perampanel was initiated at 2 mg/day and up-titrated to 4 mg/day at Week 3. Depending on response and tolerability, optional up-titrations to a maximum of 12 mg/day occurred. The primary endpoint was retention rate; additional endpoints included seizure-freedom rate, 50% responder rate, and incidence of treatment-emergent adverse events (TEAEs). At baseline, 10 (18.5%) patients were assigned to the monotherapy group and 44 (81.5%) patients to the first adjunctive therapy group. However, due to the addition of an anti-seizure medication along with perampanel on the first day of treatment, one patient was excluded from the monotherapy subgroup analyses. The mean perampanel exposure duration was 39.8 weeks and 32 (59.3%) patients completed the study. Retention rate at 12 months (or study completion) was 63.0% (monotherapy, 77.8%; first adjunctive therapy, 59.1%). Seizure-freedom rate during the Maintenance Period was 32.7% (monotherapy, 44.4%; first adjunctive therapy, 29.5%) and the 50% responder rate was 78.7% (monotherapy, 85.7%; first adjunctive therapy, 76.9%). TEAEs and serious TEAEs were reported by 88.9% (n = 48/54) and 7.4% (n = 4/54) of patients, respectively. Overall, the efficacy and safety of perampanel as monotherapy or first adjunctive therapy support the use of perampanel as early-line treatment for epilepsy.

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Section: Discussionsupporting

confidence: 89%

“…Cognitive function and QoL in patients with epilepsy can be negatively affected by poor sleep quality. The use of some ASMs can lead to disruptions in sleep quality, such as daytime sleepiness, which can worsen seizure control [ 30 ]. Here, we demonstrated that perampanel did not adversely affect sleep quality.…”

Section: Discussionmentioning

confidence: 99%

Perampanel as monotherapy or first adjunctive therapy in pediatric and adult patients with epilepsy: the first United States-based phase IV open-label ELEVATE study

Punia,

Klein,

Mihaylova

et al. 2024

J Neurol

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“…Benzodiazepines, which were commonly used in our cohort, may also increase the risk of respiratory depression and oxygen desaturation nadir. 13 Conversely, other ASMs such as carbamazepine, phenobarbitone, valproate, clobazam, clonazepam, phenytoin, and levetiracetam decrease rapid eye movement (REM) sleep 14 ; this may underscore the severity of respiratory disturbances in this patient group, which is often exacerbated during REM sleep. Other antiseizure treatments such as vagus nerve stimulation can exacerbate respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

Sleep and respiratory abnormalities in adults with developmental and epileptic encephalopathies using polysomnography and video‐EEG monitoring

Sivathamboo,

Myers,

Pattichis

et al. 2023

Epilepsia Open

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This study evaluated sleep and respiratory abnormalities, and their relationship with seizures, in adults with developmental and epileptic encephalopathies (DEEs). We studied consecutive adults with DEEs undergoing inpatient video‐EEG monitoring and concurrent polysomnography between December 2011 and July 2022. Thirteen patients with DEEs were included (median age: 31 years, range: 20–50; 69.2% female): Lennox–Gastaut syndrome (n = 6), Lennox–Gastaut syndrome‐like phenotype (n = 2), Landau–Kleffner syndrome (n = 1), epilepsy with myoclonic‐atonic seizures (n = 1), and unclassified DEEs (n = 3). Sleep architecture was often fragmented by epileptiform discharges and seizures resulting in arousals (median arousal index: 29.0 per h, range: 5.1–65.3). Moderate‐to‐severe obstructive sleep apnea (OSA) was observed in seven patients (53.8%). Three patients (23.1%) had tonic seizures that frequently occurred with central apnea; one met criteria for mild central sleep apnea. Of the patients with tonic seizures, two had other identifiable seizure manifestations, but in one patient, central apnea was commonly the only discernable seizure manifestation. Polysomnography during video‐EEG is an effective diagnostic tool in detecting sleep and seizure‐related respiratory abnormalities. Clinically significant OSA may increase the risk of comorbid cardiovascular disease and premature mortality. Treatment of epilepsy may improve sleep quality, and conversely, improved sleep, may decrease seizure burden.

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“…Among these effects, sleep-dependent interictal epileptiform events particularly during non-REM sleep ( Urbain et al, 2011 ; Bjørnæs et al, 2013 ; Galer et al, 2015 ; Halász et al, 2019 ) and sleep-related seizures ( Malow, 2007 ) partly explain hampered sleep-related memory consolidation in people with epilepsy. Additionally, anti-seizure drugs impact brain activity, e.g., by increasing or decreasing power in specific frequency bands ( Höller et al, 2018 ; Höller and Nardone, 2021 ) and they can change sleep architecture by extending or shortening specific sleep stages ( Carvalho et al, 2022 ). Thus, it is plausible that anti-seizure drugs also impact sleep-related consolidation of memory, but the exact nature of this relationship is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

The effects of slow wave sleep characteristics on semantic, episodic, and procedural memory in people with epilepsy

Höller,

Eyjólfsdóttir,

Van Schalkwijk

et al. 2024

Front. Pharmacol.

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Slow wave sleep (SWS) is highly relevant for verbal and non-verbal/spatial memory in healthy individuals, but also in people with epilepsy. However, contradictory findings exist regarding the effect of seizures on overnight memory retention, particularly relating to procedural and non-verbal memory, and thorough examination of episodic memory retention with ecologically valid tests is missing. This research explores the interaction of SWS duration with epilepsy-relevant factors, as well as the relation of spectral characteristics of SWS on overnight retention of procedural, verbal, and episodic memory. In an epilepsy monitoring unit, epilepsy patients (N = 40) underwent learning, immediate and 12 h delayed testing of memory retention for a fingertapping task (procedural memory), a word-pair task (verbal memory), and an innovative virtual reality task (episodic memory). We used multiple linear regression to examine the impact of SWS duration, spectral characteristics of SWS, seizure occurrence, medication, depression, seizure type, gender, and epilepsy duration on overnight memory retention. Results indicated that none of the candidate variables significantly predicted overnight changes for procedural memory performance. For verbal memory, the occurrence of tonic-clonic seizures negatively impacted memory retention and higher psychoactive medication load showed a tendency for lower verbal memory retention. Episodic memory was significantly impacted by epilepsy duration, displaying a potential nonlinear impact with a longer duration than 10 years negatively affecting memory performance. Higher drug load of anti-seizure medication was by tendency related to better overnight retention of episodic memory. Contrary to expectations longer SWS duration showed a trend towards decreased episodic memory performance. Analyses on associations between memory types and EEG band power during SWS revealed lower alpha-band power in the frontal right region as significant predictor for better episodic memory retention. In conclusion, this research reveals that memory modalities are not equally affected by important epilepsy factors such as duration of epilepsy and medication, as well as SWS spectral characteristics.

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Effects of antiepileptic drugs on sleep architecture parameters in adults

Cited by 11 publications

References 95 publications

Perampanel as monotherapy or first adjunctive therapy in pediatric and adult patients with epilepsy: the first United States-based phase IV open-label ELEVATE study

Perampanel as monotherapy or first adjunctive therapy in pediatric and adult patients with epilepsy: the first United States-based phase IV open-label ELEVATE study

Sleep and respiratory abnormalities in adults with developmental and epileptic encephalopathies using polysomnography and video‐EEG monitoring

The effects of slow wave sleep characteristics on semantic, episodic, and procedural memory in people with epilepsy

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