In Clinical ScienceCommentary Electrical status epilepticus during sleep (ESES) of childhood, and density of interictal activity in both children and adults impact sleep homeostasis (1). Boly et al. hypothesized that the frequency and extent of epileptic activity can disrupt sleep homeostasis, and, in turn, potentially contribute to cognitive impairment in adults with focal-onset epilepsy. The authors capitalized on a neurophysiological measure known as slow wave activity (SWA) power, a scalp EEG-derived delta power range of 1 to 4 Hz (2). SWA power dramatically decreases through a night of sleep, and therefore is thought to be a sensitive indicator of sleep need, and its underlying homeostatically regulated recovery process (3). Because sleep, especially slow wave sleep, is in a quantitative and predictive relationship with prior wakefulness, sleep disruption is associated with a proportional increase in delta range power, and a decrease with adequate to excessive sleep (2).A decrease in sleep SWA power during nonrapid eye movement (NREM) sleep is associated with promoting learning and memory consolidation (3). Enhanced synaptic strength is also associated with slow waves on EEG of larger amplitudes and steeper slopes, an example of synaptic potentiation (4, 5). In humans and animals, both global and regional sleep SWA power have been shown to increase after learning new tasks (6, 7). Boly et al. proposed that epileptic activity in adults can negatively impact sleep SWA power, and the negative slope of sleep slow waves, and correlate with cognitive impairment.Neurophysiologically, the authors investigated the potential influence of both nocturnal interictal spikes and seizures on the homeostatic alterations of NREM sleep EEG markers of SWA. The patient group in the study displayed overall shorter sleep time and sleep efficiency compared with controls. In addition, at the group level, the frequency of interictal spikes during epochs of NREM sleep was negatively correlated with the overnight decrease in negative slow wave slope. The authors demonstrated a correlation of these sleep EEG biomarkers with neuropsychological outcomes of global (full-scale) intelligence quotient and visual learning measures using the Wechsler Adult Intelligence Scale and Brief Visuospatial Memory Test-Revised, respectively.The cohort in the study included adults with either temporal or extratemporal focal-onset epilepsies. The pathophysiological underpinnings of sleep-associated thalamocortical networks, and their interplay with the ictal onset region, were inherent in the paper's discussion of the EEG biomarkers. The authors approached network connectivity from an electrophysiological perspective using high-density scalp EEG. That is, they facilitated visualiza- In animal studies, both seizures and interictal spikes induce synaptic potentiation. Recent evidence suggests that electroencephalogram slow wave activity during sleep reflects synaptic potentiation during wake, and that its homeostatic decrease during the night is associated ...