Sleep and Neurology: Overview & Epilepsy

In part 1 of a 3-part series, we take a look at what the Sleep Medicine Textbook, 2nd Edition presents on sleep and neurology, specifically a look into an overview and epilepsy.

Overview 

“A bidirectional link exists between sleep and neurological disorders, but unfortunately, this knowledge is often neglected by neurologists and sleep physicians. First, sleep-wake circadian disturbances (SWCD) are risk factors for neurological disorders: long sleep duration and sleep-disordered breathing [SDB] for stroke; insomnia and circadian distrubances for Alzheimer disease [AD]; rapid eye movement sleep behaviour disorders [RBD] for Parkinson disease [PD].

Second, SWCD are very common in neurological disorders: fatigue is present in >50% of patients with stroke, multiple sclerosis (MS) and PD; excessive daytime sleepiness in >20% of patients with PD, AD, stroke, migraine, epilepsy, and neuromuscular disorders; insomnia in 50%-90% of patients with PD and >20% of patients with AD, stroke, MS, epilepsy, and migraine; SDB in >50% of patients with stroke and >20% with PD, MS, epilepsy, headache syndromes, and neuromuscular disorders; restless legs syndrome in >10% of patients with PD, MS, and headache syndromes; RBD in >50% of patients with PD.

Third, SWCD in neurological disorders negatively affect cognition, functional outcome, mortality, and quality of life. The best management strategies for SWCD in neurological patients remain unclear for most situations, although effective treatment options are increasing. More research is needed to understand the link between neurological disorders and SWCD and the potential of targeting SWCD to prevent or modulate the course (and eventually outcome) of neurological disorders.” 

Summary by:  
Claudio Bassetti (2021). M. Sleep and Neurology 1. Overview. In Bassetti, C., McNicholas, W., Paunio, T., & Peigneux, P. (Eds.). Sleep Medicine Textbook (2nd ed., pp. 905-913). Regensburg: European Sleep Research Society. 

Epilepsy 

“Epilepsy is a chronic neurological disorder characterized by a persisting tendency to produce seizures, and by the cognitive, psychological, and social consequences of the condition. Epilepsy and sleep have a close, two-way relationship. Sleep, sleep deprivation, and sleep disorders may affect epilepsy, favouring occurrence of seizures; in turn, seizures during sleep, interictal epileptic discharges, and drugs may alter sleep structure and increase daytime sleepiness, interfering with the restorative and neuroplastic functions of sleep. Moreover, in some epilepsy syndromes such as sleep-related hypermotor epilepsy or childhood epilepsy with centrotemporal spikes, seizures mostly or exclusively occur during sleep. Such epilepsy syndromes can thus be confounded with sleep disorders, misdiagnosed, and therefore mismanaged.

Sleep assessment and sleep recording with video-polysomnography are therefore important for the diagnosis and management of patients affected by epilepsy. This chapter will provide an overview of the pathophysiology of sleep-related seizures, of the possible circadian modulation of seizures occurrence, as well as discuss the common sleep-related epileptic syndrome most likely to be encountered in the sleep laboratory. Differential diagnosis will be considered as well as the sleep-related comorbidities frequently observed in patients with epilepsy. Finally, pharmacological and non-pharmacological management of sleep-related epilepsy will be reviewed.” 

Summary by:  
Steve Gibbs, Frédéric Zubler & Lino Nobili (2021). M. Sleep and Neurology 2. Epilepsy. In Bassetti, C., McNicholas, W., Paunio, T., & Peigneux, P. (Eds.). Sleep Medicine Textbook (2nd ed., pp. 915-927). Regensburg: European Sleep Research Society.