Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy

Abstract

A healthy brain requires balancing of waking and sleeping states. The normal changes in waking and sleeping states result in neurophysiological conditions that either increase or decrease the tendency of seizures and interictal discharges to occur. This article reviews the manifold and complex relationships between sleep and epilepsy and discusses treatment of the sleep-related epilepsies. Several forms of epilepsy predominantly or exclusively manifest during sleep and seizures tend to arise especially from light NREM sleep. Diagnostic interictal epileptiform discharges on the electroencephalogram are also most likely to be activated during deep NREM sleep stage N3. Epileptiform discharges and antiepileptic medications may in turn detrimentally impact sleep. Co-morbid sleep disorders also have the potential to worsen seizure control. Sleep has an important key association with sudden unexpected death in epilepsy (SUDEP). Further research is necessary to understand the complex relationships between sleep and epileptic disorders and their treatments.

Embedding digital chronotherapy into bioelectronic medicines

“…Disruption of the sleep-wake cycle is also common in epilepsy; however, stimulation at present is not optimized for nighttime or within sleep stage operation ( Moore et al., 2021 ; Ruoff et al., 2020 ; Voges et al., 2015 ). ANT stimulation has been reported to disrupt sleep in a voltage-dependent manner, where the frequency of arousals during sleep is positively correlated with the DBS voltage ( Voges et al., 2015 ).…”

Sleep Disruption Worsens Seizures: Neuroinflammation as a Potential Mechanistic Link

“…The effects of various AEDs on sleep efficiency have been previously revised [359][360][361]. Some AEDs might affect sleep quality and architecture, causing sleepiness or drowsiness while others can lead to insomnia [362].…”

Relationship Between Epilepsy and Dreaming: Current Knowledge, Hypotheses, and Perspectives

“…Epilepsy results from the development of a neuronal hyperexcitability, due to a pathogenetic injury of various causes, which leads to recurrent focal or generalized seizures ( Devinsky et al, 2018 ). Epilepsy and sleep interact in multiple ways ( Malow, 2007 ; Grigg-Damberger and Foldvary-Schaefer, 2021 ; Moore et al, 2021 ). On the one hand, sleep has a modulating effect on epileptic activity; some epilepsy syndromes are characterized by seizures occurring almost exclusively during sleep, or by a major activation of inter-ictal epileptiform discharges during sleep, especially NREM sleep ( Frauscher and Gotman, 2019 ; Nobili et al, 2020 ).…”