Sleep Organization in Children With Partial Refractory Epilepsy

Abstract

Although it is currently known that sleep can influence epilepsy and epilepsy can influence sleep organization, few data have been published on this mutual interaction concerning the pediatric population. The objective of this study was to verify the eventual presence of sleep alterations in children with partial refractory epilepsy. Seventeen patients with partial refractory epilepsy were submitted to whole-night polysomnography as part of their epilepsy investigation. Polysomnographic recordings were performed on a digital video-electroencephalography (EEG) system and consisted of the registration of EEG (24 channels), electro-oculogram, electromyogram, electrocardiogram, and nasal airflow and abdominal respiratory movements. Sleep stages were visually scored following standard criteria, and ictal events were classified according to the international classification of seizures. The patients were also subdivided into two subgroups based on the presence or absence of ictal episodes during the recording night. The results concerning sleep organization were compared with those obtained from a normal control group. The analysis of the sleep parameters showed a reduction of total time in bed and total sleep time in both subgroups of epileptic children; there was a higher number of stage shifts per hour in the control group than in both epileptic subgroups. The percentage of stage 2 shifts is significantly reduced in patients with epilepsy and seizures during the night and the percentage of stage 3 to 4 shifts is increased. Nonsignificant differences are evident for the number of awakenings per hour and the percentage of stage 1 shifts. The percentage of rapid eye movement (REM) sleep is reduced, and first REM latency is increased in both epileptic subgroups, compared with normal controls, without statistical significance. Nine of 17 patients had seizures during the polysomnographic recording; nocturnal ictal events occurred mostly during non-REM sleep stage 2. Our results show that patients with partial refractory epilepsies have only mild sleep structure abnormalities, and this can be considered as an effect of the epileptic syndrome per se or as a result of the chronic antiepilepsy drug treatment. (J Child Neurol 2003;18:763—766).

Get full access to this article

View all access options for this article.

References

Mendez M. , Radtke RA : Interactions between sleep and epilepsy. J Clin Neurophysiol 2001;18:106—127.

Terzano MG , Parrino L. , Anelli S. , et al: Effects of generalized inter-ictal EEG discharges on sleep stability: Assessment by means of cyclic alternating pattern. Epilepsia 1992;33:317—326.

Shouse MN , Da Silva AMS, Sammaritano M: Circadian rhythm, sleep and epilepsy. J Clin Neurophysiol 1996;13:32—50.

Touchon J. , Baldy-Moulinier M. , Billiard M. , et al: Sleep organizationand epilepsy. Epilepsy Res 1991;2(Suppl):73—81.

Hrachovy RA , Frost JD , Kellaway P. : Sleep characteristics in infantile spasms. Neurology 1981;31:688—694.

Ohtahara S. , Yamatogi Y. , Ohtuka Y. : Prognosis of Lennox syndrome. Long-term clinical and electroencephalographic follow-up study, with special reference to West syndrome. Folia Psychiatr Neurol Jpn 1976;30:275—287.

Dalla Bernardina B , Beghini G. : Rolandic spikes in children with and without epilepsy (20 subjects poligraphically studied during sleep). Epilepsia 1976;17:161—167.

Commission on Classification and Terminology, International League Against Epilepsy : Epilepsia 1981;22:489—501.

Commission on Classification and Terminology, Internatioanl League Against Epilepsy : Epilepsia 1989;30:389—399.

10.

Rechtschaffen A. , Kales A. : A manual of standardized terminology, techniques and scoring system for sleep stages in human subjects. Bethesda, MD: US Department of Health, Education and Welfare, 1968. National Institute of Health publication 204.

11.

Sammaritano M. , Sherwin A. : Effect of anticonvulsants on sleep. Neurology 2000;54(Suppl 1):S16—S24.

12.

Anders TF , Sadeh A. , Appareddy V. : Normal sleep in neonates and children, in Ferber R , Kryger M (eds): Principles and Practice of Sleep Medicine in the Child. Philadelphia, WB Saunders, 1995, 7—18.

13.

Shorvon S. : Risk factors for sudden unexpected death in epilepsy. Epilepsia 1997;38(Suppl 11):S20—S22.

14.

Donner EJ , Smith CR , Snead CO III: Sudden unexplained death in children with epilepsy. Neurology 2001;57:430—434.

15.

Ferri R. , Curzi-Dascalova L. , Arzimanoglou A. , et al: Spectral analysis of heart rate variability during sleep in children with partial epilepsy. J Sleep Res 2002;11:153—160.