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Review
. 2021 Jan;18(1):170-180.
doi: 10.1007/s13311-021-01021-w. Epub 2021 Mar 30.

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

J Layne Moore  1   2 , Diego Z Carvalho  1   3 , Erik K St Louis  4   5   6   7 , Carl Bazil  8
Affiliations
Review

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

J Layne Moore et al. Neurotherapeutics. 2021 Jan.

Erratum in

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.

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Figures

Fig. 1
Fig. 1
Focal spike during N3 sleep in a patient with focal left temporal lobe epilepsy. The figure demonstrates an interictal epileptiform (spike and slow wave) discharge activated during the sleep electroencephalogram during N3 (slow wave) sleep, the stage which is most facilitatory for epileptiform activity. A spike-wave discharge with phase reversal is seen, indicating maximal electronegativity at the F7 electrode, which corresponds to the left anterior temporal region. Example shown is a 10-s screen, with sensitivity 7 uv/mm, HFF = 70 Hz, LFF = 0.3 Hz; longitudinal bipolar montage
Fig. 2
Fig. 2
Sleep activation of focal interictal epileptiform activity in a child with benign centrotemporal epilepsy. A train of repetitive focal interictal epileptiform activity in the form of centro-temporal spike discharges is seen in the example below during N2 sleep. Example shown is a 10-s screen, with sensitivity 15 uv/mm, HFF = 70 Hz, LFF = 0.3 Hz; longitudinal bipolar montage.
Fig. 3
Fig. 3
Sleep electroencephalogram showing activation of generalized epileptiform activity. Generalized spike and wave discharges typical of juvenile myoclonic epilepsy (JME) are shown in the sixth second. Example shown is a 20-s screen, with sensitivity 15 uv/mm, HFF = 70 Hz, LFF = 0.3 Hz; longitudinal bipolar montage
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