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El Youssef N, Marchi A, Bartolomei F, Bonini F, Lambert I. Sleep and epilepsy: A clinical and pathophysiological overview. Rev Neurol (Paris) 2023; 179:687-702. [PMID: 37598088 DOI: 10.1016/j.neurol.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
The interaction between sleep and epilepsy is complex. A better understanding of the mechanisms linking sleep and epilepsy appears increasingly important as it may improve diagnosis and therapeutic strategies in patients with epilepsy. In this narrative review, we aim to (i) provide an overview of the physiological and pathophysiological processes linking sleep and epilepsy; (ii) present common sleep disorders in patients with epilepsy; (iii) discuss how sleep and sleep disorders should be considered in new therapeutic approaches to epilepsy such as neurostimulation; and (iv) present the overall nocturnal manifestations and differential diagnosis between epileptic seizures and parasomnia.
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Affiliation(s)
- N El Youssef
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France
| | - A Marchi
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France
| | - F Bartolomei
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France
| | - F Bonini
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France
| | - I Lambert
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France.
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Roebber JK, Lewis PA, Crunelli V, Navarrete M, Hamandi K. Effects of Anti-Seizure Medication on Sleep Spindles and Slow Waves in Drug-Resistant Epilepsy. Brain Sci 2022; 12:1288. [PMID: 36291222 PMCID: PMC9599317 DOI: 10.3390/brainsci12101288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 09/23/2023] Open
Abstract
There is a close bidirectional relationship between sleep and epilepsy. Anti-seizure medications (ASM) act to reduce seizure frequency but can also impact sleep; this remains a relatively unexplored field given the importance of sleep on seizure occurrence, memory consolidation, and quality of life. We compared the effect of poly-ASM treatment on a night of sleep compared to an unmedicated night in patients with drug-resistant epilepsy, where ASMs were withdrawn and later restored as part of their pre-surgical evaluation. Within-subject analysis between medicated and unmedicated nights showed ASMs increased spindle (11-16 Hz) power and decreased slow wave (0.1-2 Hz) amplitude. Spindles became less strongly coupled to slow waves in the ASM night compared to no-ASM night, with effects to both the phase and strength of coupling and correlated with slow wave reduction. These effects were not seen in age-matched controls from the same unit where ASMs were not changed between two nights. Overall, we found that ASM polytherapy not only changed specific sleep waveforms, but also the fine interplay of spindle/slow wave coupling. Since these sleep oscillations impact both seizure occurrence and memory consolidation, our findings provide evidence towards a decoupling impact of ASMs on sleep that should be considered in future studies of sleep and memory disruption in people with epilepsy.
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Affiliation(s)
- Jennifer K. Roebber
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Rd., Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
| | - Penelope A. Lewis
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Rd., Cardiff CF24 4HQ, UK
| | - Vincenzo Crunelli
- Neuroscience Division, School of Bioscience, Cardiff University, Cardiff CF10 3AX, UK
| | - Miguel Navarrete
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Rd., Cardiff CF24 4HQ, UK
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Rd., Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
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Cobb SJ, Beebe LH. Quality of Life in Psychogenic Nonepileptic Seizures: An Evolutionary Concept Analysis. Issues Ment Health Nurs 2022; 43:730-736. [PMID: 35148236 DOI: 10.1080/01612840.2022.2035026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) pose a serious threat to quality of life (QOL) in patients who battle the disorder. As psychological treatment options have progressed, improvement in QOL has become a more common desired outcome. Despite its relevance in PNES research and treatment, QOL has not been defined in the PNES population. Rodgers' Evolutionary Method of concept analysis was used to analyze 47 articles and clarify the concept of QOL in PNES. QOL in PNES is subjective, multidimensional, associated with symptoms, and dynamic in nature. This conceptualization of QOL in PNES may be useful in future PNES research and treatment.
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Affiliation(s)
- Sandra J Cobb
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, USA
| | - Lora Humphrey Beebe
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, USA
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Mousa S, Latchford G, Weighall A, Nash H, Murray-Leslie R, Reuber M, Relton SD, Graham CD. Evidence of objective sleep impairment in nonepileptic attack disorder: A naturalistic prospective controlled study using actigraphy and daily sleep diaries over six nights. Epilepsy Behav 2021; 117:107867. [PMID: 33684785 DOI: 10.1016/j.yebeh.2021.107867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
Poor sleep is reported by many with nonepileptic attack disorder (NEAD) with correlations evident between self-reported sleep quality and mood and functional impairment. However, it is contended that self-reported sleep impairment in NEAD is a subjective phenomenon, which represents a general tendency to over-report symptoms or misinterpret bodily states in those with NEAD. The present study was therefore designed to investigate the extent of subjective and objective sleep impairments in those with NEAD. Over six nights we prospectively recorded comparable nightly objective (actigraphy) and subjective (consensus sleep diary) sleep parameters in a sample of 17 people with NEAD, and an age- and gender-matched normative control group (N = 20). Participants recorded daily measures of attacks, dissociation, and mood. Alongside higher subjective sleep impairment, the NEAD group had significantly worse objective sleep on several metrics compared to the normative controls, characterized by disrupted sleep (frequent awakenings and wake after sleep onset, low efficiency). Exploratory analyses using mixed effects models showed that attacks were more likely to occur on days preceded by longer, more restful sleep. This study, which had good ecological validity, evidences the presence of objective sleep impairment in NEAD, suggesting that in patient reports of problems with sleep should be given careful consideration in clinical practice.
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Affiliation(s)
- Saafi Mousa
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anna Weighall
- School of Education, University of Sheffield, Sheffield, UK
| | - Hannah Nash
- School of Psychology, University of Leeds, Leeds, UK
| | - Rebecca Murray-Leslie
- Neurology Psychotherapy Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Markus Reuber
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Samuel D Relton
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Christopher D Graham
- Department of Psychology, Queen's University Belfast, David Keir Building, Belfast, Northern Ireland, UK.
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Vanek J, Prasko J, Ociskova M, Genzor S, Holubova M, Hodny F, Nesnidal V, Slepecky M, Sova M, Minarikova K. Sleep Disturbances in Patients with Nonepileptic Seizures. Nat Sci Sleep 2021; 13:209-218. [PMID: 33623462 PMCID: PMC7896787 DOI: 10.2147/nss.s289190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Up to 20% of patients treated for epileptic seizures experience psychogenic nonepileptic paroxysms (PNES). These patients present a significant burden for the health care systems because of poor treatment outcomes. The presented review aims to summarize the current state of knowledge on sleep disturbances in patients with nonepileptic seizures. METHODS Articles were acquired via PubMed and Web of Science, and papers between January 1990 and March 2020 were extracted. Inclusion criteria were (1) published in a peer-reviewed journal: (2) studies in humans only; or (3) reviews on a related topic; (4) English language. The exclusion criteria were: (1) abstracts from conferences; (2) commentaries; (3) subjects younger than 18 years. From primary assessment, 122 articles were extracted; after obtaining full texts and secondary articles from reference lists, 45 papers were used in this review. RESULTS Limited data are available regarding sleep disorders in PNES patients, over the last 30 years only nine original research papers addressed sleep problems in patients with PNES with only six studies assessing objectively measured changes in sleep. Current literature supports the subjective perception of the sleep disturbances with mixed results in objective pathophysiological findings. Conflicting results regarding the REM phase can be found, and studies reported both shortening and prolonging of the REM phase with methodological limitations. Poor sleep quality and shortened duration have been consistently described in most of the studies. CONCLUSION Further research on a broader spectrum of patients with PNES is needed, primarily focusing on objective neurophysiological findings. Quality of life in patients suffering from PNES can be increased by good sleep habits and treatment of comorbid sleep disorders.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Samuel Genzor
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Vlastmil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Milan Sova
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
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Objectively measured sleep-wake patterns in patients with drug-resistant epilepsy - Interaction with quality of life and antiepileptic treatment. Epilepsy Behav 2020; 112:107316. [PMID: 33181903 DOI: 10.1016/j.yebeh.2020.107316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
RATIONALE Patients with epilepsy experience frequent episodes of fragmented sleep which may contribute to chronic sleep loss. Enhancing sleep patterns might lead to improved quality of life in these patients. Currently, unlike some other antiepileptic drugs (AEDs), there are no data on the effects of clobazam, a novel AED on sleep. Therefore, we tested the hypothesis that patients with epilepsy will have longer, more consolidated sleep after treatment with clobazam. METHODS In this prospective study, we included adults with drug-resistant epilepsy who were being considered for treatment with clobazam. Patients with known untreated moderate/severe sleep apnea or with major circadian rhythm disorders were excluded. We tested a set of the following subjective sleep measures: Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sleepiness Scale (ESS), Karolinska Sleepiness Scale (KSS), Insomnia Severity Index (ISI), and Quality of Life in Epilepsy (QOLIE) prior to starting the treatment, as well as after achieving a stable clobazam dose. We also measured sleep pattern using wrist actigraphy - before starting therapy and after achieving stable dose. RESULTS A total of 12 participants completed all parts of the study. After treatment, a lower number of awakenings and less wake after sleep onset (WASO) were seen, as well as a lower number of seizures. Average pretreatment bedtime was 23:45, and average wake time was 8:24. A higher seizure frequency significantly correlated with all subjective sleep measures, as well as with a higher amount actigraphy measured WASO and less total sleep time (TST) measured both by sleep log and by actigraphy. Those with higher baseline WASO by actigraphy also had more depressive symptoms, worse quality of life, longer duration of epilepsy, and a higher seizure frequency. CONCLUSION Both objective and subjective sleep metrics correlate with depressive symptoms and quality of life. After treatment, there were fewer awakenings as well as fewer seizures.
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Giussani G, Erba G, Bianchi E, Beghi E. Self-Report questionnaires for the diagnosis of psychogenic non-epileptic seizures in clinical practice. A comprehensive review of the available instruments. Seizure 2020; 79:30-43. [DOI: 10.1016/j.seizure.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
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