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Cook G, Gringras P, Hiscock H, Pal DK, Wiggs L. 'No one's ever said anything about sleep': A qualitative investigation into mothers' experiences of sleep in children with epilepsy. Health Expect 2023; 26:693-704. [PMID: 36606569 PMCID: PMC10010080 DOI: 10.1111/hex.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/16/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Sleep problems in children with epilepsy (CWE) are common. However, little is known about parental experiences and feelings about managing sleep in their CWE. To provide the most appropriate services' provision, it is essential that the lived experience of parents of this patient group and the issues and problems that they face in managing their child's sleep is understood. METHOD In 2018, nine mothers of CWE (aged 5-15 years) were interviewed about their perceptions and experiences around their child's sleep, sleep problems and their management, the impact of sleep difficulties on the child and their family and available support. RESULTS Four themes were identified that represented the nature of the child's sleep problems, including settling and night-waking issues, parasomnias and child anxiety around sleep. Seven themes represented mothers' experiences of managing their child's sleep and any associated problems, including the longstanding challenging nature of child sleep issues, management strategies adopted, challenges related to managing sleep over time, the link between sleep and seizures, the negative impact of poor sleep on daytime functioning, role of antiseizure medication and maternal concerns about child sleep. One theme represented the perceived lack of information, help and support available. CONCLUSIONS Findings suggest there are unmet needs in supporting parents to deal with sleep, sleep problems and their management in CWE. PATIENT OR PUBLIC CONTRIBUTION This individual study was conducted under the umbrella of the CASTLE research programme (see https://castlestudy.org.uk/). Parents who have lived experience of parenting a child with epilepsy were co-applicants for the programme and were involved in the original conception, aims, design and funding application for the research programme (including the project reported in this paper) and advised on project design. Mothers of CWE who have lived experience of managing sleep and sleep problems in their child were participants who shared their experiences through the interviews, which formed the data of the current study.
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Affiliation(s)
- Georgia Cook
- Department of Psychology, Health and Professional Development, Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Paul Gringras
- Children's Sleep Medicine, Evelina London Children's Hospital, London, UK.,Women and Children's Institute, Kings College London, London, UK
| | - Harriet Hiscock
- Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Medical Research Council Centre for Neurodevelopmental Disorders, King's College London, London, UK.,Department of Paediatric Neuroscience, King's College Hospital, London, UK
| | - Luci Wiggs
- Department of Psychology, Health and Professional Development, Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Hesdorffer DC, Kroner BL, Shen J, Farrell K, Roberds S, Fureman B, McDonald B, Egan L, Jones M, Weldon M, Harris M, Rice K, Campbell V, Brandish J, Kercheval C, Villas N, Meskis MA, Vogel-Farley V, Miller I, Bartenhagen M, Grabenstatter H, Utley K, Nues P, Cherry A, Vozenilek G, Sims S, Salazar TD, SanInocencio C, Forman S, Wong N, Bischoff K, Walters J, O’Boyle M, Bliss G, Davidow A, Schoyer L, DeWoody Y, Wagner K, Arcieri M, Freed A, Nye K, Nakagawa JA, Hecker J. Factors Associated with Caregiver Sleep Quality Related to Children with Rare Epilepsy Syndromes. THE JOURNAL OF PEDIATRICS: X 2020. [DOI: 10.1016/j.ympdx.2020.100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Nenadic-Baranasic N, Gjergja-Juraski R, Lehman I, Turkalj M, Nogalo B, Barisic N. Overnight Video-Polysomnographic Studies in Children with Intractable Epileptic Encephalopathies. Med Sci Monit 2018; 24:5405-5411. [PMID: 30076286 PMCID: PMC6089594 DOI: 10.12659/msm.908911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to assess sleep architecture and respiration during sleep in children with intractable epileptic encephalopathies using overnight video-polysomnography (V-PSG). Material/Methods Between 2015 to 2017 overnight V-PSG recordings were made for 31 children (22 boys and 9 girls) with intractable epileptic encephalopathy with a mean age of 6.78±3.61 years and a mean body mass index (BMI) of 15.83±3.16 kg/m3. Thirty-one healthy children were matched for sex, age, and BMI as the control group. The phases of sleep studied included rapid eye movement (REM) sleep, and non-REM (NREM) phases NREM 1, NREM 2, and NREM 3. Respiratory function during sleep was evaluated. Results Children with epileptic encephalopathies receiving antiepileptic treatment had significantly decreased total sleep time (TST) (p=0.038), significantly increased percentage of NREM1 (p=0.033), and a significantly lower percentage of total REM (p<0.0001), compared with the control group. All children 31/31 (100%) with epileptic encephalopathies had interictal epileptiform discharges, and 4/31 (12.9%) had ictal events. The number of respiratory events did not differ significantly between the two groups (p=0.118), but children in the epileptic encephalopathy group had a significantly shorter average duration (p=0.008) and longest duration (p=0.048) of respiratory events. Average (p=0.006) and least (p=0.0004) oxygen saturation (SatO2) were significantly lower in children with epileptic encephalopathies compared with the control group. Conclusions Children with epileptic encephalopathies had altered sleep architecture and marked oxygen desaturation, which supports the need for referral of children with epileptic encephalopathy for overnight sleep evaluation.
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Affiliation(s)
| | - Romana Gjergja-Juraski
- Unit for Sleep Disorders in Children, Srebrnjak Children's Hospital, Zagreb, Croatia.,School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ivan Lehman
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirjana Turkalj
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Reference Center for Clinical Pediatric Allergology of the Ministry of Health, Srebrnjak Children's Hospital, Zagreb, Croatia
| | - Boro Nogalo
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Srebrnjak Children's Hospital, Zagreb, Croatia
| | - Nina Barisic
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Halal CDS, Horta BL, Nunes ML. Polysomnographic Aspects of Sleep Architecture on Self-limited Epilepsy with Centrotemporal Spikes: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2018; 10:161-167. [PMID: 29410748 PMCID: PMC5760050 DOI: 10.5935/1984-0063.20170028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Self-limited epilepsy with centrotemporal spikes is the most common paediatric epileptic syndrome, with growing evidence linking it to various degrees and presentations of neuropsychological dysfunction. The objective of this study is to evaluate the possible sleep macro and microstructural alterations in children with this diagnosis. A systematic review of published manuscripts was carried out in Medline, LILACS and Scielo databases, using the MeSH terms epilepsy, sleep and polysomnography. From 753 retrieved references, 5 were selected, and data from macro and, when available, microstructure of sleep were extracted. Meta-analysis was performed with data from 4 studies using standardized mean difference. Findings were heterogeneous between studies, being the most frequent macrostructural findings a smaller proportion and greater latency of REM sleep in two studies and, in meta-analysis, a longer sleep latency was the most significant finding among epileptic patients. Only one study evaluated sleep microstructure, suggesting possible alterations in cyclic alternating pattern in diagnosed children. Studies evaluating macro and microstructure of sleep in children with self-limited epilepsy with centrotemporal spikes are necessary to a better understanding of mechanisms of the neuropsychologic disturbances that are frequently seen in children with this diagnosis.
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Affiliation(s)
- Camila Dos Santos Halal
- Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), PhD Program of Medicine and Health Sciences - Porto Alegre - Rio Grande do Sul - Brazil.,Conceição Hospital Group, Hospital Criança Conceição - Porto Alegre - Rio Grande do Sul - Brazil
| | - Bernardo Lessa Horta
- Universidade Federal de Pelotas, Postgraduate Program in Epidemiology, Pelotas, Rio Grande do Sul, Brazil
| | - Magda Lahorgue Nunes
- Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine and Brain Institute (BRAIns), Division of Neurology, Porto Alebre, Rio Grande do Sul, Brazil
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Neto FK, Noschang R, Nunes ML. The relationship between epilepsy, sleep disorders, and attention deficit hyperactivity disorder (ADHD) in children: A review of the literature. ACTA ACUST UNITED AC 2016; 9:158-163. [PMID: 28123654 PMCID: PMC5241617 DOI: 10.1016/j.slsci.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Abstract
Objective To analyze the relationship between epilepsy, sleep disorders, and attention deficit hyperactivity disorder (ADHD). Bibliographic search A literature search of the PubMed database was performed using the following key words: epilepsy, sleep, and ADHD. In total, 91 articles were located in PubMed, 34 were selected for abstract reading and twelve articles were reviewed, in which the main objectives were examine the relationship between epilepsy, sleep and ADHD from several perspectives, including epidemiology, effect of comorbidities on academic performance and the factors leading to diagnostic difficulties among these three disorders Results Among the main findings, there were difficulties to start and maintain sleep in patients with epilepsy and ADHD, reduction in sleep efficiency, decreased seizure threshold, as well as behavioral and cognitive deficits in both groups. Conclusions It is important to know which symptom is the predominant one. For this reason, children and adolescents with epilepsy, ADHD and sleep disorders need to be assessed carefully before initiating treatment. Our review concluded that there is an important link in this pathological triad.
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Affiliation(s)
- Felipe Kalil Neto
- Division of Neurology, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renan Noschang
- Pontifícia Universidade Católica do Rio Grande do Sul, School of Medicine, Brazil
| | - Magda Lahorgue Nunes
- Division of Neurology, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, School of Medicine, Brazil; Brain Institute (InsCer) PUCRS, Brazil
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Rizou I, De Gucht V, Papavasiliou A, Maes S. The contribution of illness perceptions to fatigue and sleep problems in youngsters with epilepsy. Eur J Paediatr Neurol 2016; 20:93-9. [PMID: 26497901 DOI: 10.1016/j.ejpn.2015.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/10/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aims to explore the extent to which gender, epilepsy severity and illness perceptions predict fatigue and sleep problems in youngsters with epilepsy. METHOD Structured interviews were conducted in 100 young patients (Mage = 13,9, SD = 2.21; 41% girls) and data were analyzed by means of multiple hierarchical regression analyses. RESULTS Most patients (91%) were well controlled by anti-epileptics; 3% had infrequent seizures and 6% were pharmacoresistant. At a multivariate level it appeared that youngsters with epilepsy who believe that they have less personal control over their illness and who feel that the illness has a high emotional impact on their lives reported higher levels of fatigue. In addition, more sleep problems were reported by youngsters who think they have less personal control over the disease, who believe that treatment controls epilepsy and report that the disease has a high emotional impact on their lives. CONCLUSION Given the importance of illness perceptions, it is suggested that they are targets for future interventions that aim to reduce fatigue and sleep problems in youngsters with epilepsy.
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Affiliation(s)
- Ioanna Rizou
- Child Psychiatry Department, Mental Health Center of General Hospital of Athens "G. Gennimatas", Athens, Greece.
| | - Veronique De Gucht
- Health, Medical and Neuropsychology Department, Leiden University, Leiden, The Netherlands.
| | | | - Stan Maes
- Health, Medical and Neuropsychology Department, Leiden University, Leiden, The Netherlands.
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Nunes ML, Bruni O. Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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8
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Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. J Pediatr (Rio J) 2015; 91:S26-35. [PMID: 26392218 DOI: 10.1016/j.jped.2015.08.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/09/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To review the clinical characteristics, comorbidities, and management of insomnia in childhood and adolescence. SOURCES This was a non-systematic literature review carried out in the PubMed database, from where articles published in the last five years were selected, using the key word "insomnia" and the pediatric age group filter. Additionally, the study also included articles and classic textbooks of the literature on the subject. DATA SYNTHESIS During childhood, there is a predominance of behavioral insomnia as a form of sleep-onset association disorder (SOAD) and/or limit-setting sleep disorder. Adolescent insomnia is more associated with sleep hygiene problems and delayed sleep phase. Psychiatric (anxiety, depression) or neurodevelopmental disorders (attention deficit disorder, autism, epilepsy) frequently occur in association with or as a comorbidity of insomnia. CONCLUSIONS Insomnia complaints in children and adolescents should be taken into account and appropriately investigated by the pediatrician, considering the association with several comorbidities, which must also be diagnosed. The main causes of insomnia and triggering factors vary according to age and development level. The therapeutic approach must include sleep hygiene and behavioral techniques and, in individual cases, pharmacological treatment.
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Larson AM, Ryther RCC, Jennesson M, Geffrey AL, Bruno PL, Anagnos CJ, Shoeb AH, Thibert RL, Thiele EA. Impact of pediatric epilepsy on sleep patterns and behaviors in children and parents. Epilepsia 2012; 53:1162-9. [PMID: 22594377 DOI: 10.1111/j.1528-1167.2012.03515.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Disrupted sleep patterns in children with epilepsy and their parents are commonly described clinically. A number of studies have shown increased frequency of sleep disorders among pediatric epilepsy patients; however, few have characterized the association between epilepsy and parental sleep quality and household sleeping arrangements. The purpose of this study was to explore the effect of pediatric epilepsy on child sleep, parental sleep and fatigue, and parent-child sleeping arrangements, including room sharing and cosleeping. METHODS Parents of children 2 to 10 years of age with and without epilepsy completed written questionnaires assessing seizure history, child and parent sleep, and household sleeping arrangements. Children's Sleep Habits Questionnaire (CSHQ) scores were used to evaluate sleep disturbances for the child. The Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) were used to evaluate parental sleep and fatigue, respectively. The Early Childhood Epilepsy Severity Scale (E-Chess) was used to assess epilepsy severity. KEY FINDINGS One hundred five households with a child with epilepsy and 79 controls participated in this study. Households with a child with epilepsy reported increased rates of both parent-child room sharing (p < 0.001) and cosleeping (p = 0.005) compared to controls. Children with epilepsy were found to have greater sleep disturbance by total CSHQ score (p < 0.001) and the following subscores: parasomnias (p < 0.001), night wakings (p < 0.001), sleep duration (p < 0.001), daytime sleepiness (<0.001), sleep onset delay (p = 0.009), and bedtime resistance (p = 0.023). Parents of children with epilepsy had increased sleep dysfunction (p = 0.005) and were more fatigued (p < 0.001). Severity of epilepsy correlated positively with degree of child sleep dysfunction (0.192, p = 0.049), parental sleep dysfunction (0.273, p = 0.005), and parental fatigue (0.324, p = 0.001). Antiepileptic drug polytherapy was predictive of greater childhood sleep disturbances. Nocturnal seizures were associated with parental sleep problems, whereas room sharing and cosleeping behavior were associated with child sleep problems. Within the epilepsy cohort, 69% of parents felt concerned about night seizures and 44% reported feeling rested rarely or never. Finally, 62% of parents described decreased sleep quality and/or quantity with cosleeping. SIGNIFICANCE Pediatric epilepsy can significantly affect sleep patterns for both the affected child and his or her parents. Parents frequently room share or cosleep with their child, adaptations which may have detrimental effects for many households. Clinicians must not only be attentive to the sleep issues occurring in pediatric patients with epilepsy, but also for the household as a whole. These data provide evidence of a profound clinical need for improved epilepsy therapeutics and the development of nocturnal seizure monitoring technologies.
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Affiliation(s)
- Anna M Larson
- Pediatric Epilepsy Program, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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10
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Current World Literature. Curr Opin Neurol 2011; 24:183-90. [DOI: 10.1097/wco.0b013e32834585ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Golde EGA, Gutter T, de Weerd AW. Sleep disturbances in people with epilepsy; prevalence, impact and treatment. Sleep Med Rev 2011; 15:357-68. [PMID: 21439869 DOI: 10.1016/j.smrv.2011.01.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 01/14/2011] [Accepted: 01/15/2011] [Indexed: 11/30/2022]
Abstract
The interaction between epilepsy and sleep is thoroughly studied and is very complex. This review focuses on prevalence, impact on quality of life and effects of treatment of sleep disorders on the course of epilepsy. Self-reported sleep disturbances in people with epilepsy are about twice as prevalent as in healthy controls. People with epilepsy with sleep disturbances have a significant impairment of quality of life compared to those with no sleep disturbances. In children with epilepsy, sleep problems may lead to detrimental effects on daytime behavior and cognition. Most is known about obstructive sleep apnea syndrome (OSAS). Co-morbidity of epilepsy and OSAS is shown to be far higher than expected by chance. Treatment of OSAS significantly improves seizure control in people with epilepsy. More studies on the prevalence of other sleep disorders in people with epilepsy and the effect of treatment are required. Reports on the effect of treatment for other sleep disorders are scarce and not unequivocal.
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Affiliation(s)
- Esther G A van Golde
- Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle, Dokter Denekampweg 20, 8025 BV Zwolle, The Netherlands.
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Chan S, Baldeweg T, Cross JH. A role for sleep disruption in cognitive impairment in children with epilepsy. Epilepsy Behav 2011; 20:435-40. [PMID: 21310668 DOI: 10.1016/j.yebeh.2010.12.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 12/27/2010] [Accepted: 12/28/2010] [Indexed: 12/01/2022]
Abstract
Early-onset epilepsy is associated with a poor cognitive outcome, with the cumulative burden of both ictal and interictal epileptiform discharges likely to contribute significantly. Memory consolidation has been shown to occur during sleep in healthy children, with an associated electroencephalographic signature. This may be disrupted in children with epilepsy, who exhibit a high incidence of sleep disorders, whether directly related to their seizures or as a comorbidity. Conversely, seizure semiology may be influenced by sleep. In this review we present clinical and experimental evidence that suggests that the disruption of sleep architecture by epileptiform discharges may be an important factor contributing to cognitive impairment in children with epilepsy.
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Affiliation(s)
- S Chan
- Neurosciences Unit, UCL Institute of Child Health, London, UK
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