Temporal relationship between awakening and seizure onset in nocturnal partial seizures

Yıldız, F.; Tezer, F. İrsel; Saygı, Serap

doi:10.1016/j.jns.2011.12.009

Cited by 13 publications

(14 citation statements)

References 23 publications

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“…We observed that the vast majority of sleep‐related seizures was followed by awakenings or arousals. This result is in line with 2 previous scalp EEG studies reporting high rates of awakenings following sleep‐related focal seizures (72% and 65%) 23,24 . Discordant results were found by Gumusyayla et al, with 64% of nocturnal temporal lobe seizures following arousals/awakenings 25 .…”

Section: Discussionsupporting

confidence: 91%

“…This result is in line with 2 previous scalp EEG studies reporting high rates of awakenings following sleep-related focal seizures (72% and 65%). 23,24 Discordant results were found by Gumusyayla et al, with 64% of nocturnal temporal lobe seizures following arousals/awakenings. 25 This discrepancy is likely explained by the limits of scalp EEG for detecting the precise timing of seizure onset in case of focal deep epileptic foci.…”

Section: Seizures Disrupt Sleepmentioning

confidence: 74%

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Sleep Disruption in Epilepsy: Ictal and Interictal Epileptic Activity Matter

Peter‐Derex

Klimeš

Latreille

et al. 2020

Annals of Neurology

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Objective: Disturbed sleep is common in epilepsy. The direct influence of nocturnal epileptic activity on sleep fragmentation remains poorly understood. Stereo-electroencephalography paired with polysomnography is the ideal tool to study this relationship. We investigated whether sleep-related epileptic activity is associated with sleep disruption. Methods: We visually marked sleep stages, arousals, seizures, and epileptic bursts in 36 patients with focal drugresistant epilepsy who underwent combined stereo-electroencephalography/polysomnography during presurgical evaluation. Epileptic spikes were detected automatically. Spike and burst indices (n/sec/channel) were computed across four 3-second time windows (baseline sleep, pre-arousal, arousal, and post-arousal). Sleep stage and anatomic localization were tested as modulating factors. We assessed the intra-arousal dynamics of spikes and their relationship with the slow wave component of non-rapid eye-movement sleep (NR) arousals. Results: The vast majority of sleep-related seizures (82.4%; 76.5% asymptomatic) were followed by awakenings or arousals. The epileptic burst index increased significantly before arousals as compared to baseline and postarousal, irrespective of sleep stage or brain area. A similar pre-arousal increase was observed for the spike index in NR stage 2 and rapid eye-movement sleep. In addition, the spike index increased during the arousal itself in neocortical channels, and was strongly correlated with the slow wave component of NR arousals (r = 0.99, p < 0.0001). Interpretation: Sleep fragmentation in focal drug-resistant epilepsy is associated with ictal and interictal epileptic activity. The increase in interictal epileptic activity before arousals suggests its participation in sleep disruption. An additional increase in the spike rate during arousals may result from a sleep-wake boundary instability, suggesting a bidirectional relationship.

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Section: Discussionsupporting

confidence: 91%

Section: Seizures Disrupt Sleepmentioning

confidence: 74%

Sleep Disruption in Epilepsy: Ictal and Interictal Epileptic Activity Matter

Peter‐Derex

Klimeš

Latreille

et al. 2020

Annals of Neurology

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“…The phenomenon has been implemented in the clinic where sleep deprivation is used to activate epileptic activity in case when a routine diagnostic electroencephalographic (EEG) procedure failed (51,52). It has been shown that in a group of focal epilepsies temporal and occipital lobe seizures prevailed during wakefulness, whereas frontal lobe seizures during sleep (42,44,48,(53)(54)(55)(56). Interestingly, this relationship changes with age.…”

Section: Circadian Rhythms In Epilepsymentioning

confidence: 99%

Circadian Rhythms and Epilepsy: A Suitable Case for Absence Epilepsy

Smyk

Luijtelaar

2020

Front. Neurol.

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Many physiological processes such as sleep, hormonal secretion, or thermoregulation, are expressed as daily rhythms orchestrated by the circadian timing system. A powerful internal clock mechanism ensures proper synchronization of vital functions within an organism on the one hand, and between the organism and the external environment on the other. Some of the pathological processes developing in the brain and body are subjected to circadian modulation as well. Epilepsy is one of the conditions which symptoms often worsen at a very specific time of a day. Variation in peak occurrence depends on the syndrome and localization of the epileptic focus. Moreover, the timing of some types of seizures is closely related to the sleep-wake cycle, one of the most prominent circadian rhythms. This review focuses on childhood absence epilepsy (CAE), a genetic generalized epilepsy syndrome, in which both, the circadian and sleep influences play a significant role in manifestation of symptoms. Human and animal studies report rhythmical occurrence of spike-wave discharges (SWDs), an EEG hallmark of CAE. The endogenous nature of the SWDs rhythm has been confirmed experimentally in a genetic animal model of the disease, rats of the WAG/Rij strain. Well-known detrimental effects of circadian misalignment were demonstrated to impact the severity of ongoing epileptic activity. SWDs are vigilance-dependent in both humans and animal models, occurring most frequently during passive behavioral states and light slow-wave sleep. The relationship with the sleep-wake cycle seems to be bidirectional, while sleep shapes the rhythm of seizures, epileptic phenotype changes sleep architecture. Circadian factors and the sleep-wake states dependency have a potential as add-ons in seizures' forecasting. Stability of the rhythm of recurrent seizures in individual patients has been already used as a variable which refines existing algorithms for seizures' prediction. On the other hand, apart from successful pharmacological approach, circadian hygiene including sufficient sleep and avoidance of internal desynchronization or sleep loss, may be beneficial for patients with epilepsy in everyday management of seizures.

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“…Tonic-clonic evolution: midnight–3 AM and 6 AM–9 AM.2. Generalized EEG onset: more tonic-clonic evolution between 9:00–12 PM.Yildiz et al, 2012 [110]Retrospective68 patients – FLE and TLEDuration between awakening and seizure onset.1. Seizure onsets before awakening: 49 seizures (FLE: 20, TLE: 29).2.…”

Section: Seizure Patterns In Epilepsymentioning

confidence: 99%

Chronopharmacology of Anti-Convulsive Therapy

Ramgopal

Thomé‐Souza

Loddenkemper

2013

Curr Neurol Neurosci Rep

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Approximately one-third of patients with epilepsy continue to have seizures despite antiepileptic therapy. Many seizures occur in diurnal, sleep/wake, circadian, or even monthly patterns. The relationship between biomarkers and state changes is still being investigated, but early results suggest that some of these patterns may be related to endogenous circadian patterns whereas others may be related to wakefulness and sleep or both. Chronotherapy, the application of treatment at times of greatest seizure susceptibility, is a technique that may optimize seizure control in selected patients. It may be used in the form of differential dosing, as preparations designed to deliver sustained or pulsatile drug delivery or in the form of ‘zeitgebers’ that shift endogenous rhythms. Early trials in epilepsy suggest that chronopharmacology may provide improved seizure control compared with conventional treatment in some patients. The present article reviews chronopharmacology in the treatment of epilepsy as well as future treatment avenues.

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Temporal relationship between awakening and seizure onset in nocturnal partial seizures

Cited by 13 publications

References 23 publications

Sleep Disruption in Epilepsy: Ictal and Interictal Epileptic Activity Matter

Sleep Disruption in Epilepsy: Ictal and Interictal Epileptic Activity Matter

Circadian Rhythms and Epilepsy: A Suitable Case for Absence Epilepsy

Chronopharmacology of Anti-Convulsive Therapy

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