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Zhidik AG, Kozhokaru AB. [Alternative methods of therapy for comorbid sleep disorders as a method of choice in adult patients with epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:42-48. [PMID: 37655409 DOI: 10.17116/jnevro202312308142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Systematization and generalization of data from domestic and foreign literature on alternative methods of treatment of sleep disorders in epilepsy. MATERIAL AND METHODS The search for data from domestic and foreign literary sources was carried out in the electronic databases Medline (PubMed), Scopus, Web of Science, eLibrary, CyberLeninka, Google Scholar. RESULTS The data of modern randomized trials, meta-analyzes on the effectiveness of various non-traditional methods as a method of choice for epilepsy with comorbid sleep disorders have been analyzed. CONCLUSIONS Complementary (alternative) treatments have many advantages over the classical pharmacotherapy of sleep disorders in epilepsy, in the form of non-invasiveness, low incidence of side-effects, ease of use, and lack of a dose-dependent effect. Of course, the targets of most of the above methods are not focused and not very specific, and the sample size is too small to obtain impartial and meaningful clinical conclusions, but this once again emphasizes the urgent need for large-scale clinical trials, which is necessary to develop evidence-based treatments for comorbid sleep disorders in epilepsy.
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Affiliation(s)
- A G Zhidik
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - A B Kozhokaru
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
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Peng W, Ding J, Wang X. The Management and Alternative Therapies for Comorbid Sleep Disorders in Epilepsy. Curr Neuropharmacol 2021; 19:1264-1272. [PMID: 33380304 PMCID: PMC8719297 DOI: 10.2174/1570159x19666201230142716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/29/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a complex and interactive relationship between sleep and epilepsy. Sleep disorders are common in patients with epilepsy, and methods for managing sleep disorders in patients with epilepsy are limited. OBJECTIVE This review addresses the relationship among sleep, sleep disorders, and epilepsy, focusing on the management of sleep disorders in epilepsy, including some complementary and alternative therapies. METHODS The terms related to "sleep" and "epilepsy" were searched in "Pubmed" and "Cochrane Library". RESULTS Sleep stages differently affect both seizures and interictal epileptiform discharges. Seizures disrupt sleep architecture greatly, especially when occurring during sleep in the night. Insomnia and obstructive sleep apnea (OSA) are the most frequent types of comorbid sleep disorders in patients with epilepsy. Pharmacological agents with both anti-convulsant and sedative effects are the priorities for comorbid sleep disorders in epilepsy. Continuous positive airway pressure (CPAP) therapy is the most effective non-pharmacological method to improve OSA and reduce seizures. Complementary and alternative therapies such as Chinese traditional medicine, cognitive behavioral therapy, meditation, yoga, neurofeedback, and acupuncture may have benefits in reducing seizures and improving sleep quality simultaneously by alleviating stress and seizure triggers; however, evidence- based therapies are still deficient. CONCLUSION Management of sleep disorders in patients with epilepsy is challenging. Large-scale randomized controlled clinical trials are in demand to guide the treatments in the future.
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Affiliation(s)
| | - Jing Ding
- Address correspondence to this author at the Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China; Tel: 86-21-64041990-2926; Fax: 86-21-34160748; E-mail:
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NREM parasomnia as a dream enacting behavior. Sleep Med 2020; 75:103-105. [DOI: 10.1016/j.sleep.2020.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 11/23/2022]
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Quantitative analysis of phenotypic elements augments traditional electroclinical classification of common familial epilepsies. Epilepsia 2019; 60:2194-2203. [PMID: 31625138 PMCID: PMC7145322 DOI: 10.1111/epi.16354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Classification of epilepsy into types and subtypes is important for both clinical care and research into underlying disease mechanisms. A quantitative, data-driven approach may augment traditional electroclinical classification and shed new light on existing classification frameworks. METHODS We used latent class analysis, a statistical method that assigns subjects into groups called latent classes based on phenotypic elements, to classify individuals with common familial epilepsies from the Epi4K Multiplex Families study. Phenotypic elements included seizure types, seizure symptoms, and other elements of the medical history. We compared class assignments to traditional electroclinical classifications and assessed familial aggregation of latent classes. RESULTS A total of 1120 subjects with epilepsy were assigned to five latent classes. Classes 1 and 2 contained subjects with generalized epilepsy, largely reflecting the distinction between absence epilepsies and younger onset (class 1) versus myoclonic epilepsies and older onset (class 2). Classes 3 and 4 contained subjects with focal epilepsies, and in contrast to classes 1 and 2, these did not adhere as closely to clinically defined focal epilepsy subtypes. Class 5 contained nearly all subjects with febrile seizures plus or unknown epilepsy type, as well as a few subjects with generalized epilepsy and a few with focal epilepsy. Family concordance of latent classes was similar to or greater than concordance of clinically defined epilepsy types. SIGNIFICANCE Quantitative classification of epilepsy has the potential to augment traditional electroclinical classification by (1) combining some syndromes into a single class, (2) splitting some syndromes into different classes, (3) helping to classify subjects who could not be classified clinically, and (4) defining the boundaries of clinically defined classifications. This approach can guide future research, including molecular genetic studies, by identifying homogeneous sets of individuals that may share underlying disease mechanisms.
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Licchetta L, Vignatelli L, Zenesini C, Mostacci B, Ferri L, Provini F, Tinuper P, Bisulli F. Sleep‐related hypermotor epilepsy: A prediction cohort study on sleep/awake patterns of seizures. Epilepsia 2019; 60:e115-e120. [DOI: 10.1111/epi.16369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Licchetta
- IRCCS, Istituto delle Scienze Neurologiche di Bologna Bologna Italy
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - Luca Vignatelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - Corrado Zenesini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - Barbara Mostacci
- IRCCS, Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - Federica Provini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna Bologna Italy
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - Paolo Tinuper
- IRCCS, Istituto delle Scienze Neurologiche di Bologna Bologna Italy
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - Francesca Bisulli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna Bologna Italy
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
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Abstract
Multiple inpatient psychiatric hospitalizations can be due to system issues, patient complexity, family dynamics, and misdiagnoses to name a few. This study highlights a diagnostically challenging case and how that, in itself, contributed to hospital admissions. Although 18 months elapsed from the time of the initial presentation to the diagnosis of non-epileptic seizures (NES), the suspicion of the diagnosis may have been made earlier by clinicians. The evidence for seizures of post-ictal confusion followed by lethargy, amnesia for the event, and response to an anti-seizure medication only could have provided a higher index of suspicion for NES. Many health care providers will argue that this will create over-diagnoses of NES and usage of anti-epileptic medications. While reviewing the literature on NES, it was noted that frontal lobe epilepsy (FLE) causing psychiatric comorbidities has been poorly studied. Furthermore, this case highlights that within the field of child psychiatry, the same clinical presentation can be interpreted differently. This case helps us understand how eliciting clinical information to enable the timely ordering of imaging could help in diagnoses. This may help set up clinical guidelines for NES for the mental health providers to facilitate improvement in diagnoses and treatment.
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Affiliation(s)
- Sonia Gaur
- Psychiatry, Stanford University, Stanford, USA
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Stefani A, Heidbreder A, Brandauer E, Guaita M, Neier LM, Mitterling T, Santamaria J, Iranzo A, Videnovic A, Trenkwalder C, Sixel-Döring F, Wenning GK, Chade A, Poewe W, Gershanik OS, Högl B. Screening for idiopathic REM sleep behavior disorder: usefulness of actigraphy. Sleep 2018; 41:4939057. [PMID: 29554362 PMCID: PMC5995165 DOI: 10.1093/sleep/zsy053] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/04/2018] [Indexed: 12/20/2022] Open
Abstract
Study Objectives To evaluate the utility of multimodal low-cost approaches including actigraphy, a wrist-worn device monitoring rest/activity cycles, in identifying patients with idiopathic REM sleep behavior disorder (iRBD). Methods Seventy patients diagnosed with sleep disorders causing different motor manifestations during sleep (iRBD, sleep apnea, restless legs syndrome) and 20 subjects without any relevant motor manifestation during sleep, underwent video-polysomnography (vPSG) and 2 week actigraphy, completed six validated RBD screening questionnaires, and sleep apps use was assessed. Actigraphy was analyzed automatically, and visually by seven blinded sleep medicine experts who rated as "no," "possible," and "probable" RBD. Results Quantitative actigraphy analysis distinguished patients from controls, but not between patients with different types of motor activity during sleep. Visual actigraphy rating by blinded experts in sleep medicine using pattern recognition identified vPSG confirmed iRBD with 85%-95% sensitivity, 79%-91% specificity, 81%-91% accuracy, 57.7% ± 11.3% positive predictive value, 95.1% ± 3.3% negative predictive value, 6.8 ± 2.2 positive likelihood ratio, 0.14 ± 0.05 negative likelihood ratio and 0.874-0.933 area under the ROC curve (AUC). AUC of the best performing questionnaire was 0.868. Few patients used sleep apps; therefore, their potential utility in the evaluated patients' groups is limited. Conclusions Visual analysis of actigraphy using pattern recognition can identify subjects with iRBD, and is able to distinguish iRBD from other motor activities during sleep, even when patients are not aware of the disease in contrast to questionnaires. Therefore, actigraphy can be a reliable screening instrument for RBD potentially useful in the general population.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marc Guaita
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lisa-Marie Neier
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Mitterling
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Aleksander Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Claudia Trenkwalder
- Department of Neurosurgery, University Medical Center, Göttingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
| | - Friederike Sixel-Döring
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anabel Chade
- Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Oscar S Gershanik
- Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Iranzo A, Santamaria J, Tolosa E. Idiopathic rapid eye movement sleep behaviour disorder: diagnosis, management, and the need for neuroprotective interventions. Lancet Neurol 2016; 15:405-19. [PMID: 26971662 DOI: 10.1016/s1474-4422(16)00057-0] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 12/21/2022]
Abstract
Idiopathic rapid eye movement (REM) sleep behaviour disorder (IRBD) manifests as unpleasant dreams and vigorous behaviours during REM sleep that can result in injuries. Patients with IRBD have no known neurological diseases or motor or cognitive complaints; however, this sleep disorder is not harmless. In most cases, IRBD is the prelude of the synucleinopathies Parkinson's disease, dementia with Lewy bodies, or, less frequently, multiple system atrophy. Patients can show abnormalities that are characteristic of the synucleinopathies, and longitudinal follow-up shows that most patients develop parkinsonism and cognitive impairments with time. Thus, diagnosis of IRBD needs to be accurate and involves informing the patient of the risk of developing a neurodegenerative disease. It is extraordinary for a sleep disorder to precede the full expression of a neurodegenerative disease, which renders IRBD of particular interest in studies of the prodromal stage of the synucleinopathies, and in the development of neuroprotective interventions to stop or slow neurodegenerative deterioration before motor and cognitive symptomatology emerges. Such therapeutics do not currently exist, and thus represent an unmet need in IRBD.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain.
| | - Joan Santamaria
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Eduardo Tolosa
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
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Altered intrinsic connectivity networks in frontal lobe epilepsy: a resting-state fMRI study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:864979. [PMID: 25525456 PMCID: PMC4261631 DOI: 10.1155/2014/864979] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/12/2014] [Accepted: 11/02/2014] [Indexed: 11/18/2022]
Abstract
Examining the resting-state networks (RSNs) may help us to understand the neural mechanism of the frontal lobe epilepsy (FLE). Resting-state functional MRI (fMRI) data were acquired from 46 patients with FLE (study group) and 46 age- and gender-matched healthy subjects (control group). The independent component analysis (ICA) method was used to identify RSNs from each group. Compared with the healthy subjects, decreased functional connectivity was observed in all the networks; however, in some areas of RSNs, functional connectivity was increased in patients with FLE. The duration of epilepsy and the seizure frequency were used to analyze correlation with the regions of interest (ROIs) in the nine RSNs to determine their influence on FLE. The functional network connectivity (FNC) was used to study the impact on the disturbance and reorganization of FLE. The results of this study may offer new insight into the neuropathophysiological mechanisms of FLE.
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Derry CP. Sleeping in fits and starts: a practical guide to distinguishing nocturnal epilepsy from sleep disorders. Pract Neurol 2014; 14:391-8. [DOI: 10.1136/practneurol-2014-000890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
PURPOSE OF REVIEW An understanding of the impact of sleep on neurologic disorders, and the impact of neurologic disorders on sleep, provides fresh opportunities for neurologists to improve the quality of life and functioning of their patients. RECENT FINDINGS Sleep-disordered breathing (SDB) is a risk factor for cerebrovascular disease and should be considered in all TIA and stroke patients. Sleep disorders can amplify nociception and worsen headache disorders; and some headaches, including those related to SDB and hypnic headache, are sleep specific. REM sleep behavior disorder may be an early sign of neurodegenerative disease. Focal lesions of almost any etiology (eg, multiple sclerosis and CNS malignancies) in the hypothalamus, basal forebrain, or brainstem may result in sleep disturbance, sleepiness, and insomnia. Sleep-related hypoventilation and fatigue are common in neuromuscular disease. SDB and epilepsy are mutually facilitatory, and poor sleep can exacerbate epilepsy. SUMMARY Continued surveillance for sleep disorders by neurologists is rewarded by new treatment avenues in their patients with the possibility of improved clinical outcomes.
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Affiliation(s)
- Nathaniel F Watson
- Harborview Medical Center, UW Medicine Sleep Center, 325 Ninth Ave, Box 359803, Seattle, WA 98104, USA.
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De Paolis F, Colizzi E, Milioli G, Grassi A, Riccardi S, Puligheddu M, Terzano MG, Marrosu F, Parrino L. Effects of antiepileptic treatment on sleep and seizures in nocturnal frontal lobe epilepsy. Sleep Med 2013; 14:597-604. [DOI: 10.1016/j.sleep.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 02/15/2013] [Accepted: 02/22/2013] [Indexed: 10/26/2022]
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Abstract
The ways in which sleep can affect epilepsy, and epilepsy can influence sleep and wakefulness, are described. Different forms of sleep disturbance have been reported in patients with epilepsy, depending on the type of seizure disorder. Confusions between epilepsy and non-epileptic parasomnias can be a particular diagnostic problem but they can be avoided. Untreated sleep disturbance is likely to have harmful psychological, physical and family effects. Screening for sleep disturbance should be routine, and leading, if indicated, to precise diagnosis of the underlying sleep disorder on which choice of advice and treatment depends.
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Affiliation(s)
- Gregory Stores
- Department of Psychiatry, University of Oxford, c/o North Gate House, 55 High Street, Dorchester on Thames, Oxon X10 7HN, UK.
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Abstract
The intimate relationship between sleep and epilepsy has long been recognized, yet our understanding of the relationship is incomplete. In this article we address four key issues in this area. First, we consider the reciprocal interaction between sleep and epilepsy. Sleep state clearly influences seizure onset, particularly in certain epilepsy syndromes. The converse is also true; epilepsy may disrupt sleep, either directly through seizures and epileptiform activity, or indirectly through medication-related effects. Unraveling the influences of sleep stage, epilepsy syndrome, and drug effects is challenging, and the current state of knowledge is reviewed. Secondly, accurate diagnosis of sleep-related epilepsy can be difficult, particularly the distinction of nocturnal frontal lobe epilepsy (NFLE) from arousal parasomnias. The challenges in this area, along with work from the authors, are discussed. Thirdly, we will explore the putative relationship between obstructive sleep apnea (OSA) and epilepsy, including the effect of OSA on quality of life; this will lead us to a brief exploration of the effects of OSA on neuroendocrine function. Finally, we will review the evidence surrounding the role of sleep in sudden unexpected death in epilepsy (SUDEP).
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Affiliation(s)
- Christopher P Derry
- Edinburgh and South East Scotland Epilepsy Service, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
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Abstract
OPINION STATEMENT Treatment of violent behaviors in sleep depends on the underlying condition and a correct identification of the causative disorder is mandatory. After eliminating possible precipitating factors, pharmacological treatment is often required to control violent sleep behaviors. Although no drugs are specifically approved for the treatment of parasomnias and placebo-controlled trials are lacking in these patient populations, clonazepam is considered the drug of choice in the management of both Non-REM and REM parasomnias. Benzodiazepines may cause unwanted side effects especially in older individuals and tolerance is sometime observed. Melatonin and pramipexole may represent alternative options in REM sleep behavior disorder. Hypnosis therapy may be considered in arousal disorders when pharmacological treatment is contraindicated or ineffective. Management of nocturnal frontal lobe epilepsy include a first-step pharmacological approach with antiepileptic drugs (eg, carbamazepine, oxcarbazepine or other drugs effective on partial seizures), but surgical options may be considered in drug refractory patients. The published evidence for the efficacy of various treatments relies mostly upon case series or case reports.
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Affiliation(s)
- Maria Livia Fantini
- Sleep Disorders Center, Department of Neurosciences, University of Turin, Ospedale San Giovanni Battista - Molinette, Via Cherasco 15, 10126, Torino, Italy,
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