Effect of successful epilepsy surgery on subjective and objective sleep parameters – a prospective study

Abstract: SummaryObjective Sleep is considered restorative, and good quantity and quality sleep is required for memory consolidation and synaptic plasticity. Sleep disorders are common in patients with epilepsy. Poor sleep quality or quantity may worsen seizure control. On the other end, seizures and epilepsy may worsen the sleep quality and set a vicious cycle. In addition, antiepileptic drugs have an effect on sleep architecture. We performed a systemic literature review with a goal to evaluate the effect of antiepileptic drugs and nondrug treatments for epilepsy on sleep architecture to help better understand treatment effects, especially in patients with epilepsy and sleep problems. Methods We searched PubMed and identified studies that evaluated objective sleep outcomes for an antiepileptic drug. We also searched for studies with objective sleep outcomes that evaluated other epilepsy treatments such as epilepsy surgery, vagus nerve stimulation, and ketogenic diet. Results The studies were categorized based on evidence class and study population for an individual antiepileptic drug or treatment. We identified that most antiepileptic drugs and nondrug treatments for epilepsy affect sleep architecture. Significance We identified that gabapentin, tiagabine, pregabalin, clobazam, and carbamazepine reduce sleep latency and/or improve sleep efficiency. Phenobarbital, valproic acid, and higher-dose levetiracetam aggravate daytime sleepiness, whereas topiramate and zonisamide do not. Vagus nerve stimulation reduces daytime sleepiness, and ketogenic diet improves slow-wave sleep. Epilepsy surgery may improve nocturnal sleep only in a subgroup of patients with improved seizure frequency. Further studies are needed to evaluate the dose-dependent sleep effects of antiepileptic drugs and nondrug treatments independent of the improvement of epilepsy, and to identify if these changes are clinically significant.

Abstract: During the last decade, many clinical and pathophysiological aspects of sleep-related epileptic and non-epileptic paroxysmal behaviors have been clarified. Advances have been achieved in part through the use of intracerebral recording methods such as stereo-electroencephalography (S-EEG), which has allowed a unique "in vivo" neurophysiological insight into focal epilepsy. Using S-EEG, the local features of physiological and pathological EEG activity in different cortical and subcortical structures have been better defined during the entire sleep-wake spectrum. For example, S-EEG has contributed to clarify the semiology of sleep-related seizures as well as highlight the specific epileptogenic networks involved during ictal activity. Moreover, intracerebral EEG recordings derived from patients with epilepsy have been valuable to study sleep physiology and specific sleep disorders. The occasional co-occurrence of NREM-related parasomnias in epileptic patients undergoing S-EEG investigation has permitted the recordings of such events, highlighting the presence of local electrophysiological dissociated states and clarifying the underlying pathophysiological substrate of such NREM sleep disorders. Based on these recent advances, the authors review and summarize the current and relevant S-EEG literature on sleep-related hypermotor epilepsies and NREM-related parasomnias. Finally, novel data and future research hypothesis will be discussed.

Abstract: Sleep plays an intricate role in the disease process of epilepsy. Despite the complexity of this relationship, the prognosis is a favorable one for patients presenting with sleep disorders and epilepsy. Clinicians need to be vigilant about asking about and addressing sleep complaints in patients with epilepsy. Ultimately, improving sleep and optimizing seizure control can have significant positive effects on the quality of life of these patients.

Abstract: This chapter outlines an interaction between sleep and epilepsy including effect of sleep on epilepsy, epilepsy on sleep, and antiepileptic medication on sleep, preceded by a brief discussion about mechanism of epilepsy and sleep. We also mention about the impact of autonomic nervous system and sleep apnea in epilepsy. Finally, we discuss about special seizure types occurring during night as well as diagnostic procedures and practical relevance to understanding the relationship between sleep and epilepsy.

Abstract: Background Sleep and epilepsy are mutually related in a complex, bidirectional manner. However, our understanding of this relationship remains unclear. Results The literatures of the neurobiological basis of the interactions between sleep and epilepsy indicate that non rapid eye movement sleep and idiopathic generalized epilepsy share the same thalamocortical networks. Most of neurotransmitters and neuromodulators such as adenosine, melatonin, prostaglandin D2, serotonin, and histamine are found to regulate the sleep-wake behavior and also considered to have antiepilepsy effects; antiepileptic drugs, in turn, also have effects on sleep. Furthermore, many drugs that regulate the sleep-wake cycle can also serve as potential antiseizure agents. The nonpharmacological management of epilepsy including ketogenic diet, epilepsy surgery, neurostimulation can also influence sleep. Conclusion In this paper, we address the issues involved in these phenomena and also discuss the various therapies used to modify them.

Abstract: The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.

Abstract: Prologue: toward a surgical cure for epilepsy - the work of Wilder Penfield and his school at the Montreal Neurologic Institute, William Feindel. Part 1 Identification of surgical candidates. Part 2 Non-invasive pre-operative evaluation. Part 3 Invasive pre-operative evaluation. Part 4 Surgical treatment. Part 5 Post-operative follow-up. Epilogue: general impressions of the past-present and future, Herbert H. Jasper. Appendices: historical perspectives, Jerome Engel Jr pre-surgical evaluation protocols guidelines for multi-centre research, B. Vickrey et al basic research in the setting of an epilepsy surgery centre, P. Schwartzkroin.

Abstract: ic (speech sound) encoding of the word in the context of an utterance. The first four chapters of the book investigate the ability to transform a message we are thinking to the word-forms required for i t s expression. Taken together, th i s section describes the process of moving from a concept to the selection of a lexical item, and provides a computer model for lemma retrieval that involves mental activation spreading from a triggered concept to the word-form stage. It appears that lemma retrieval obeys both semantic (meaning) and grammatical (structural) constraints available from the word‘s context, and that failures in lexical selection in pathologic states may be related to semantic or grammatical category effects. The next three chapters of the book are concerned with the phonetic realization of a word-form. Words themselves have a characteristic structure, and it appears that the structure of a word plays an important role in eliciting a speech error. Methodologic issues have restricted the nature of speech error analyses in normal subjects, and a critical examination of the aphasic speech error literature has additionally revealed that few investigators have examined error consistency in individual aphasics. Inconsistent speech error patterns in aphasia are unlikely to be due to the actual loss of phonologic information, but instead to the compromised transmission of information between processing subsystems. This book will be of most immediate interest to aphasiologists, but its significance for a much larger audience should not be lost. The contributors illustrate important new approaches to the assessment of human cognition in individuals with CNS disease. It is through the efforts of researchers such as these that nonspecific behavioral descriptors such as ”word-finding difficulty” will soon be replaced by more meaningful characterizations that are theoretically motivated and therapeutically significant.