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Sleep Disorders in Epileptic Patients: the Role of Epilepsy and the Role of Aeds

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Sleep Disorders in Epileptic Patients: the Role of Epilepsy and the Role of Aeds Central Journal of Veterinary Medicine and Research Editorial *Corresponding author Verrotti A, Department of Pediatrics, University of Perugia, Sant’andreadelleFratte; Fax: +39-075-5784415; Sleep Disorders in Epileptic Email: Submitted: 07 July 2014 Patients: The Role of Epilepsy Accepted: 16 July 2014 Published: 18 July 2014 Copyright and the Role of AEDs © 2014 Verrotti et al. Verrotti A*, d’Alonzo R and Rinaldi VE OPEN ACCESS Department of Pediatrics, University of Perugia, Italy Epilepsy and sleep disorders are major health problems and sleep abnormalities such as increased number and duration of the prevalence of sleep disorders in children with epilepsy is under recognized. Childhoodsleep disturbances originate from fragmented REM sleep and increased stage shifts [7]. Among the factors that are not closely related to the primary neurological causesawakenings of sleep during fragmentation, sleep, reduced sleep sleep related efficiency, breathing reduced disorders and disorder but are multifactorial in origin and include poor sleep hygiene, detrimental effects of seizures on sleep, effects of antiepileptic drugs and coexistence of primary sleep disorders havecan be a dysfunctionconsidered ofa trigger the arousal for seizures system controland IEDS. which This can suggests be due or comorbid illness [1]. In general, children with epilepsy tothat the children effect of with a primary obstructive brain sleep insult apnea as a predisposing syndrome (OSAS) factor may for experience alterations in total sleep, sleep architecture, sleep latency and spontaneous arousals with a higher incidence of sleep fragmentation and daytime drowsiness [2]. In particular, both OSAS and paroxysmal EEG activity [9]. Therefore treatment NREM sleep is important for declarative memory consolidation seizuresof these disorders not only with may potentiallydirect effects improve on neuronal seizure excitability control. On butthe whereas REM sleep is involved in non declarative and emotional alsoother by hand stabilizing antiepileptic sleep anddrugs reducing (AEDs) sleepexert atransitions. beneficial actionWhether on memory [3]. Sleep related paroxysmal disorders in infancy and the improvement in sleep patterns is a direct consequence of the with the distinction of nocturnal epilepsy from non epileptic sleepchildhood disorders represent [4]. Thea significant AmericanAcademy challenge offor Sleep the cliniciansMedicine onuse sleep of AEDs have or been the studied consequence independent of the ofsuppression seizures showing of epileptic both manifestations is the object of many debates. The effects of AEDs 2) dividing sleep disorders mimicking epilepsy in three groups: NREM(AASM) and in 2005,REM parasomnias,elaborated an sleep international related movement classification disorders (ICSD- candetrimental be weight and beneficialinducing, effects.therefore AEDs fragmenting affect sleep architecturesleep [11]. by inducing sedation or insomnia [10]. In addition some AEDs studies have analyzed these effects. In particular Class 1 studies mostand otherimportant paroxysmal amongst nocturnalthese are nocturnal events [5]. frontal Sleep lobe has epilepsy well- inVirtually healthy all adults AEDs suggest have effects that phenobarbitalon sleep architecture and levetiracetam and many documented association with specific epilepsy syndromes. The (FLE), benign epilepsy with centro-temporal spikes (BECTS), wavereduce sleep REM in sleep the same whereas type itof is population enhanced whileby gabapentin it is increased [12- statusbenign epilepticus epilepsy of during childhood slow withwave occipital sleep. The paroxysms amount of (BECOP), baseline by13]. levetiracetam,Other studies demonstratedpregabalin and that tiagabine. clobazam Clobazamdecreases slowalso rhythmicityLandau-Kleffner occurring syndrome in brain (LKS), differs infantile considerably spams and between electrical the reduces sleep latency and arousals/wake time also reduced by states of sleep and wakefulness. It is therefore not surprising that levetiracetam, phenobarbital, tiagabine and pregabalin [14]. Class 3 evidence based studies show that carbamazepine favours [6]. The neurophysiologic process involved in the deepening various seizures types begin preferentially in specific sleep states wave sleep in healthy subjects and diminishes sleep latency, sleep efficiency and extends total sleep time increasing slow of synchronizationNREM sleep may between also facilitate the brainsten both seizuresreticular andactivating inter- 1 evidence based studies in epileptic adult patients showed that system,ictalepileptiform thalamus discharges and cortex. (IEDS). A progressive NREM sleep hyperpolarization represents state pregabalinarousals REM increases sleep and slow wake wave time sleep [15]. thatOn the is insteadother hand reduced class by levetiracetam [16]. Moreover, phenobarbital and gabapentin of the effect of acetylcholine which contributes to NREM sleep reduce sleep latency and arousals. Regarding slow wave sleep of thalamo-cortical neurons is also determined by a reduction it has been seen that carbamazepine and gabapentin have an deepening [7]. In contrast, REM sleep tends to suppress IEDS and were seen with lamotrigine on REM sleep and slow wave sleep Seizuresmay restrict are most their likely field toof occurdistribution during theto the descent epileptogenic to deeper origin levels enhancing effect contrarily to ethosuximide. Conflicting results by inhibition of thalamo-cortical synchronizing mechanisms [8]. REM sleep that was not demonstrated with the administration [17]. Phenobarbital and phenytoin cause a reduction in patients of sleep. Patients with epilepsy generally have macrostructural Cite this article: Verrotti A, d’Alonzo R, Rinaldi VE (2014) Sleep Disorders in Epileptic Patients: The Role of Epilepsy and the Role of AEDs. J Sleep Med Disord1(1): 1001. Verrotti et al. (2014) Email: Central of ethosuximide or gabapentin. Finally class 3 evidence based 6. studies show that phenobarbital increases daytime sleepiness, 7. Bazil CW. Nocturnal seizures. Semin Neurol. 2004; 24: 293-300. an effect that was not seen when topiramate, lamotrigine, zonisamide or vigabatrin were administered to epileptic patients Kothare SV, Kaleyias J. Sleep and epilepsy in children and adolescents. Sleep Med. 2010; 11: 674-685. alterations in children with refractory epileptic encephalopathies: a 8. Carotenuto M, Parisi P, Esposito M, Cortese S, Elia M. Sleep studies[18]. There a reduction are very fewof sleep studies latency concerning in this epileptic population patients could with be obtainedproblems initiatingby using sleep.phenytoin, On the phenobarbital, basis of previously carbamazepine performed polysomnographic study. Epilepsy Behav. 2014; 35: 50-53. and clobazam. Another domain where further clinical trials are 9. Miano S, Paolino MC, Peraita-Adrados R, Montesano M, Barberi S, Villa MP,. Prevalence of EEG paroxysmal activity in a population of children 10. with obstructive sleep apnea syndrome. Sleep. 2009; 32: 522-529. required is that of epileptic patients with difficulty maintining Casalino T, et al. Sleep disorders in children with cerebral palsy: having a positive effect on sleep consolidation could potentially Romeo DM, Brogna C, Quintiliani M, Baranello G, Pagliano E, sleep. Gabapentin, tiagabin or pregabalin increasing N3 and neurodevelopmental and behavioral correlates. Sleep Med. 2014; 15: that could be explored are epileptic patients with insomnia or achieve a good maintenance of sleep [19]. Another two aspects 11. 213-218. Kothare SV, Kaleyias J. The adverse effects of antiepileptic drugs in with excessive daytime sleepiness. In the first case these subjects or pregabalin; on the other hand it is important to avoid the 12. children. Expert Opin Drug Saf. 2007; 6: 251-265. associationcould beneficiate of phenobarbital, from a therapy valproic with acidcarbamazepine, and levetiracetam tiagabine in Karacan I, Orr W, Roth T, Kramer M, Thornby J, Bingham S, Kay D. patients with daytime drowsiness. Dose-related effects of phenobarbitone on human sleep-waking 13. The complicated and reciprocal relationship between sleep patterns. Br J Clin Pharmacol. 1981; 12: 303-313. of levetiracetam on nocturnal sleep and daytime vigilance in healthy and epilepsy is a topic that has been intriguing physicians and Cicolin A, Magliola U, Giordano A, Terreni A, Bucca C, Mutani R,. Effects researchers for many years. Whether sleep affects epilepsy or 14. volunteers. Epilepsia. 2006; 47: 82-85. Nicholson AN, Stone BM, Clarke CH. Effect of the 1,5-benzodiazepines, andepilepsy sleep modifies disorders sleep in the has pediatric been extensively population. evaluated Future [20]. research Very clobazam and triflubazam, on sleep in man. Br J Clin Pharmacol. 1977; shouldlittle literature explore existspossible on therapeuticthe mutual interaction applications of ofepilepsy, antiepileptic AEDs 15. 4: 567-572. drugs in epileptic patients presenting sleep comorbidities [7]. Riemann D, Gann H, Hohagen F, Bahro M, Müller WE, Berger M,. The effect of carbamazepine on endocrine and sleep EEG variables REFERENCES in a patient with 48-hour rapid cycling, and healthy controls. 1. 16. Neuropsychobiology. 1993; 27: 163-170. Exploratory polysomnographic evaluation of pregabalin on sleep Bazil CW. Epilepsy and sleep disturbance. Epilepsy Behav. 2003; 4 de Haas S, Otte A, de Weerd A, van Erp G, Cohen A, van Gerven J,. 2. Suppl 2: S39-45. disturbance in patients with epilepsy. J Clin Sleep Med. 2007; 3: 473- MR,Carney editors.
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