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Berteotti C, Calvello C, Liguori C. Role of the orexin system in the bidirectional relation between sleep and epilepsy: New chances for patients with epilepsy by the antagonism to orexin receptors? Epilepsia 2023; 64:1991-2005. [PMID: 37212716 DOI: 10.1111/epi.17661] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 05/23/2023]
Abstract
Epilepsy is a common neurological disorder, affecting patients of all ages, reducing the quality of life, and associated with several comorbidities. Sleep impairment is a frequent condition in patients with epilepsy (PWE), and the relation between sleep and epilepsy has been considered bidirectional, as one can significantly influence the other, and vice versa. The orexin system was described more than 20 years ago and is implicated in several neurobiological functions other than in controlling the sleep-wake cycle. Considering the relation between epilepsy and sleep, and the significant contribution of the orexin system in regulating the sleep-wake cycle, it is conceivable that the orexin system may be affected in PWE. Preclinical studies investigated the impact of the orexin system on epileptogenesis and the effect of orexin antagonism on seizures in animal models. Conversely, clinical studies are few and propose heterogeneous results also considering the different methodological approaches to orexin levels quantification (cerebrospinal-fluid or blood samples). Because orexin system activity can be modulated by sleep, and considering the sleep impairment documented in PWE, the recently approved dual orexin receptor antagonists (DORAs) have been suggested for treating sleep impairment and insomnia in PWE. Accordingly, sleep improvement can be a therapeutic strategy for reducing seizures and better managing epilepsy. The present review analyzes the preclinical and clinical evidence linking the orexin system to epilepsy, and hypothesizes a model in which the antagonism to the orexin system by DORAs can improve epilepsy by both a direct and a sleep-mediated (indirect) effect.
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Affiliation(s)
- Chiara Berteotti
- Physiological Regulation in Sleeping Mice Lab, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Carmen Calvello
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
- Sleep Medicine Center, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
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Sheibani M, Shayan M, Khalilzadeh M, Ghasemi M, Dehpour AR. Orexin receptor antagonists in the pathophysiology and treatment of sleep disorders and epilepsy. Neuropeptides 2023; 99:102335. [PMID: 37003137 DOI: 10.1016/j.npep.2023.102335] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
The correlation between sleep and epilepsy has been argued over the past decades among scientists. Although the similarities and contrasts between sleep and epilepsy had been considered, their intertwined nature was not revealed until the nineteenth century. Sleep is recognized as a recurring state of mind and body through alternating brain electrical activities. It is documented that sleep disorders are associated with epilepsy. The origin, suppression, and spread of seizures are affected by sleep. As such, in patients with epilepsy, sleep disorders are a frequent comorbidity. Meanwhile, orexin, a wake-promoting neuropeptide, provides a bidirectional effect on both sleep and epilepsy. Orexin and its cognate receptors, orexin receptor type 1 (OX1R) and type 2 (OX2R), orchestrate their effects by activating various downstream signaling pathways. Although orexin was considered a therapeutic target in insomnia shortly after its discovery, its potential usefulness for psychiatric disorders and epileptic seizures has been suggested in the pre-clinical studies. This review aimed to discuss whether the relationship between sleep, epilepsy, and orexin is clearly reciprocal.
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Affiliation(s)
- Mohammad Sheibani
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Razi Drug Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Shayan
- Experimental Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Khalilzadeh
- Experimental Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Ghasemi
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA.
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Filin AA, Tardov MV, Kunelskaya NL, Vlasov PN. The use of perampanel in drug-resistant focal epilepsy: its effect on sleep. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2020. [DOI: 10.14412/2074-2711-2020-6-49-53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Perampanel (PER) is an antiepileptic drug (AED), the effects of which on sleep have not been studied in Russia.Objective: to assess changes in the quality of sleep, the level of daytime sleepiness, and the polysomnographic (PSG) characteristics of nocturnal sleep in patients with drug-resistant focal epilepsy when PER is incorporated into the therapy regimen as an additional AED.Patients and methods. The investigation enrolled 12 patients (4 men and 8 women) aged 21 to 49 years with drug-resistant epilepsy treated with several AEDs, who had initiated therapy with PER as an additional AED. PSG study and questioning survey were done before and 1 month after initiation of PER therapy.Results and discussion. After one month of PER therapy, there was an increase in the quality of night sleep in 5 cases and a reduction in daytime sleepiness in 6 cases. The PSG pattern was stable in 3 patients, worsened in 1, and improved in 8.Conclusion. The preliminary results suggest that PER therapy improves night sleep quality and reduces daytime sleepiness in about half of the cases, as evidenced by the improved PSG pattern in 67% of patients.
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Affiliation(s)
- A. A. Filin
- L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Healthcare Department
| | - M. V. Tardov
- L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Healthcare Department
| | - N. L. Kunelskaya
- L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Healthcare Department;
N.I. Pirogov Russian Research Medical University, Ministry of Health of Russia
| | - P. N. Vlasov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
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Iyer SH, Matthews SA, Simeone TA, Maganti R, Simeone KA. Accumulation of rest deficiency precedes sudden death of epileptic Kv1.1 knockout mice, a model of sudden unexpected death in epilepsy. Epilepsia 2017; 59:92-105. [PMID: 29193044 DOI: 10.1111/epi.13953] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Chronic sleep deficiency is associated with early mortality. In the epileptic population, there is a higher prevalence of sleep disorders, and individuals with severe refractory epilepsy are at greater risk of premature mortality than the general population. Sudden unexpected death in epilepsy affects 1:1000 cases of epilepsy each year. Ketogenic diet (KD) treatment is one of the few effective options for refractory seizures. Despite KD reducing seizures and increasing longevity in Kv1.1 knockout (KO) mice, they still succumb to sudden death. This study aims to determine whether (1) the rest profiles of KO and KD-treated KO (KOKD) mice resemble each other as a function of either age or proximity to death and (2) the timing of death correlates with acute or chronic changes in rest. METHODS Noninvasive actimetry was used to monitor rest throughout the lives of KO and wild-type (WT) littermates administered standard diet or KD. RESULTS As KO mice age, rest is reduced (P < .0001). Rest is significantly improved in KDKO mice (P < .0001), resembling WT values at several ages. When age is removed as a variable and data are realigned to the day of death, the rest profiles of KO and KOKD groups worsen to similar degrees as a function of proximity to death. The amount of rest acutely is not sensitive to the timing of death, whereas chronic rest deficiency profiles (10-15 days prior to death) of both groups were indistinguishable. Chronic accumulation of rest deficiency over the final 15 days was associated with 75% of deaths. SIGNIFICANCE Our data suggest that the accumulated rest deficiency is associated with sudden death in Kv1.1 KO mice. These data (1) support the proposed clinical hypothesis that chronic sleep deficiency may be associated with early mortality in epileptic patients and (2) warrant future preclinical and clinical studies on sleep monitoring in epileptic patients.
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Affiliation(s)
- Shruthi H Iyer
- Department of Pharmacology, Creighton University School of Medicine, Omaha, NE, USA
| | - Stephanie A Matthews
- Department of Pharmacology, Creighton University School of Medicine, Omaha, NE, USA
| | - Timothy A Simeone
- Department of Pharmacology, Creighton University School of Medicine, Omaha, NE, USA
| | - Rama Maganti
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kristina A Simeone
- Department of Pharmacology, Creighton University School of Medicine, Omaha, NE, USA
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Sleep abnormalities in juvenile myoclonic epilepsy—A sleep questionnaire and polysomnography based study. Seizure 2017; 50:194-201. [DOI: 10.1016/j.seizure.2017.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/10/2017] [Accepted: 06/17/2017] [Indexed: 11/19/2022] Open
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Giuliano L, Uccello D, Fatuzzo D, Mainieri G, Zappia M, Sofia V. Electroclinical findings of minor motor events during sleep in temporal lobe epilepsy. Epilepsia 2017; 58:1261-1267. [DOI: 10.1111/epi.13770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”; University of Catania; Catania Italy
| | - Denise Uccello
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”; University of Catania; Catania Italy
| | - Daniela Fatuzzo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”; University of Catania; Catania Italy
| | - Greta Mainieri
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”; University of Catania; Catania Italy
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”; University of Catania; Catania Italy
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”; University of Catania; Catania Italy
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Abstract
SummaryIntroduction.Medial temporal lobe epilepsy (MTLE) is the most frequent form of epilepsy in adulthood. It is classified as local/regional epilepsy. However, there is increasing evidence of the involvement of both temporal lobes and this provides abundant arguments to question this view, and consider MTLE as one of the typical bilateral system epilepsies.Aim.To provide a contemporary review of medial temporal lobe epilepsy, discussing the bilateral aspects, with reference to epilepsy surgery.Methods.A literature review and a resume of the author’s own experiences with MTLE patients.Results.Recent electrophysiological and neuroimaging data provide convincing data supporting that MTLE is a bilateral disease. The uni-and bilateral features form a continuum and the participation rate of the two temporal lobes determine course and surgical perspective of the individual patient.Conclusions.The contradictory data of invasive presurgical evaluations of MTLE patients suggest that there need to identify further indicatory markers of bilaterality and thus change the presurgical evaluation from the non-invasive towards the invasive ways. The mechanisms of the interrelationship between the two temporal lobes in MTLE warrants further research.
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Goncharova II, Alkawadri R, Gaspard N, Duckrow RB, Spencer DD, Hirsch LJ, Spencer SS, Zaveri HP. The relationship between seizures, interictal spikes and antiepileptic drugs. Clin Neurophysiol 2016; 127:3180-3186. [PMID: 27292227 DOI: 10.1016/j.clinph.2016.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 05/01/2016] [Accepted: 05/16/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE A considerable decrease in spike rate accompanies antiepileptic drug (AED) taper during intracranial EEG (icEEG) monitoring. Since spike rate during icEEG monitoring can be influenced by surgery to place intracranial electrodes, we studied spike rate during long-term scalp EEG monitoring to further test this observation. METHODS We analyzed spike rate, seizure occurrence and AED taper in 130 consecutive patients over an average of 8.9days (range 5-17days). RESULTS We observed a significant relationship between time to the first seizure, spike rate, AED taper and seizure occurrence (F (3,126)=19.77, p<0.0001). A high spike rate was related to a longer time to the first seizure. Further, in a subset of 79 patients who experienced seizures on or after day 4 of monitoring, spike rate decreased initially from an on- to off-AEDs epoch (from 505.0 to 382.3 spikes per hour, p<0.00001), and increased thereafter with the occurrence of seizures. CONCLUSIONS There is an interplay between seizures, spikes and AEDs such that spike rate decreases with AED taper and increases after seizure occurrence. SIGNIFICANCE The direct relationship between spike rate and AEDs and between spike rate and time to the first seizure suggests that spikes are a marker of inhibition rather than excitation.
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Affiliation(s)
- Irina I Goncharova
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Rafeed Alkawadri
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Nicolas Gaspard
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Robert B Duckrow
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Dennis D Spencer
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Susan S Spencer
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Hitten P Zaveri
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Roundtree HM, Simeone TA, Johnson C, Matthews SA, Samson KK, Simeone KA. Orexin Receptor Antagonism Improves Sleep and Reduces Seizures in Kcna1-null Mice. Sleep 2016. [PMID: 26446112 DOI: 10.5665/sleep.5444.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE Comorbid sleep disorders occur in approximately one-third of people with epilepsy. Seizures and sleep disorders have an interdependent relationship where the occurrence of one can exacerbate the other. Orexin, a wake-promoting neuropeptide, is associated with sleep disorder symptoms. Here, we tested the hypothesis that orexin dysregulation plays a role in the comorbid sleep disorder symptoms in the Kcna1-null mouse model of temporal lobe epilepsy. METHODS Rest-activity was assessed using infrared beam actigraphy. Sleep architecture and seizures were assessed using continuous video-electroencephalography-electromyography recordings in Kcna1-null mice treated with vehicle or the dual orexin receptor antagonist, almorexant (100 mg/kg, intraperitoneally). Orexin levels in the lateral hypothalamus/perifornical region (LH/P) and hypothalamic pathology were assessed with immunohistochemistry and oxygen polarography. RESULTS Kcna1-null mice have increased latency to rapid eye movement (REM) sleep onset, sleep fragmentation, and number of wake epochs. The numbers of REM and non-REM (NREM) sleep epochs are significantly reduced in Kcna1-null mice. Severe seizures propagate to the wake-promoting LH/P where injury is apparent (indicated by astrogliosis, blood-brain barrier permeability, and impaired mitochondrial function). The number of orexin-positive neurons is increased in the LH/P compared to wild-type LH/P. Treatment with a dual orexin receptor antagonist significantly increases the number and duration of NREM sleep epochs and reduces the latency to REM sleep onset. Further, almorexant treatment reduces the incidence of severe seizures and overall seizure burden. Interestingly, we report a significant positive correlation between latency to REM onset and seizure burden in Kcna1-null mice. CONCLUSION Dual orexin receptor antagonists may be an effective sleeping aid in epilepsy, and warrants further study on their somnogenic and ant-seizure effects in other epilepsy models.
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Affiliation(s)
| | - Timothy A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Chaz Johnson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | | | - Kaeli K Samson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Kristina A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
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Roundtree HM, Simeone TA, Johnson C, Matthews SA, Samson KK, Simeone KA. Orexin Receptor Antagonism Improves Sleep and Reduces Seizures in Kcna1-null Mice. Sleep 2016; 39:357-68. [PMID: 26446112 DOI: 10.5665/sleep.5444] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/28/2015] [Indexed: 01/14/2023] Open
Abstract
STUDY OBJECTIVE Comorbid sleep disorders occur in approximately one-third of people with epilepsy. Seizures and sleep disorders have an interdependent relationship where the occurrence of one can exacerbate the other. Orexin, a wake-promoting neuropeptide, is associated with sleep disorder symptoms. Here, we tested the hypothesis that orexin dysregulation plays a role in the comorbid sleep disorder symptoms in the Kcna1-null mouse model of temporal lobe epilepsy. METHODS Rest-activity was assessed using infrared beam actigraphy. Sleep architecture and seizures were assessed using continuous video-electroencephalography-electromyography recordings in Kcna1-null mice treated with vehicle or the dual orexin receptor antagonist, almorexant (100 mg/kg, intraperitoneally). Orexin levels in the lateral hypothalamus/perifornical region (LH/P) and hypothalamic pathology were assessed with immunohistochemistry and oxygen polarography. RESULTS Kcna1-null mice have increased latency to rapid eye movement (REM) sleep onset, sleep fragmentation, and number of wake epochs. The numbers of REM and non-REM (NREM) sleep epochs are significantly reduced in Kcna1-null mice. Severe seizures propagate to the wake-promoting LH/P where injury is apparent (indicated by astrogliosis, blood-brain barrier permeability, and impaired mitochondrial function). The number of orexin-positive neurons is increased in the LH/P compared to wild-type LH/P. Treatment with a dual orexin receptor antagonist significantly increases the number and duration of NREM sleep epochs and reduces the latency to REM sleep onset. Further, almorexant treatment reduces the incidence of severe seizures and overall seizure burden. Interestingly, we report a significant positive correlation between latency to REM onset and seizure burden in Kcna1-null mice. CONCLUSION Dual orexin receptor antagonists may be an effective sleeping aid in epilepsy, and warrants further study on their somnogenic and ant-seizure effects in other epilepsy models.
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Affiliation(s)
| | - Timothy A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Chaz Johnson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | | | - Kaeli K Samson
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
| | - Kristina A Simeone
- Pharmacology Department, Creighton University School of Medicine, Omaha, NE
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Masino SA, Kawamura M, Ruskin DN. Adenosine receptors and epilepsy: current evidence and future potential. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2014; 119:233-55. [PMID: 25175969 PMCID: PMC6026023 DOI: 10.1016/b978-0-12-801022-8.00011-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adenosine receptors are a powerful therapeutic target for regulating epileptic seizures. As a homeostatic bioenergetic network regulator, adenosine is perfectly suited to establish or restore an ongoing balance between excitation and inhibition, and its anticonvulsant efficacy is well established. There is evidence for the involvement of multiple adenosine receptor subtypes in epilepsy, but in particular the adenosine A1 receptor subtype can powerfully and bidirectionally regulate seizure activity. Mechanisms that regulate adenosine itself are increasingly appreciated as targets to thus influence receptor activity and seizure propensity. Taken together, established evidence for the powerful potential of adenosine-based epilepsy therapies and new strategies to influence receptor activity can combine to capitalize on this endogenous homeostatic neuromodulator.
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Affiliation(s)
- Susan A Masino
- Department of Psychology and Neuroscience Program, Trinity College, Hartford, Connecticut, USA.
| | - Masahito Kawamura
- Department of Pharmacology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - David N Ruskin
- Department of Psychology and Neuroscience Program, Trinity College, Hartford, Connecticut, USA
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Ramachandraiah CT, Sinha S, Taly AB, Rao S, Satishchandra P. Interrelationship of sleep and juvenile myoclonic epilepsy (JME): a sleep questionnaire-, EEG-, and polysomnography (PSG)-based prospective case-control study. Epilepsy Behav 2012; 25:391-6. [PMID: 23103316 DOI: 10.1016/j.yebeh.2012.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/06/2012] [Accepted: 08/08/2012] [Indexed: 11/16/2022]
Abstract
We studied the effects of 'epilepsy on sleep and its architecture' and 'sleep on the occurrence and distribution of interictal epileptiform discharges (ED)' using 'sleep questionnaires', 'EEG', and 'PSG' in patients with JME. Forty patients with JME [20 on valproate (Group I - 20.8±4.0 years; M: F=9:11) and 20 drug-naïve (Group II - 24.4±6.7 years; M: F=9:11)] and 20 controls (M: F=9:11; age: 23.5±4.7 years) underwent assessment with Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), overnight PSG, and scalp-EEG. Epileptiform discharges (EDs) were quantified in different sleep stages. The 'ED Index' was derived as number of EDs/min per stage. Statistical Package for the Social Sciences (SPSS) vs. 11 was used for statistical analysis. A 'p' <0.05 was considered as statistically significant. There was poor sleep quality in patients compared to controls (p=0.02), while there was no significant difference in ESS scores between the groups. The PSG parameters were comparable in both groups. Routine EEG revealed EDs in 22/40 (Group I: 7 and Group II: 15) patients. Thirty-five patients had EDs in various sleep stages during PSG (Group I: 17 and Group II: 18): N1 - Group I: 9 and Group II: 14, N2 - Group I: 14 and Group II: 14, N3 - Group I: 14 and Group II: 10, and REM - Group I: 9 and Group II: 11. The ED Index was higher during N2/N3 in Group I and N1/REM in Group II. The epileptiform discharges were frequently associated with arousals in N1/REM and K-complexes in N2. There was no other significant difference between Groups I and II. In conclusion, there was poor sleep quality in patients with JME compared to controls, especially those on valproate who had altered sleep architecture. Epileptiform activity was observed more often in sleep than wakefulness. Sleep stages had variable effect on epileptiform discharges with light sleep having a facilitatory effect in the drug-naïve group and slow wave sleep having a facilitatory effect in the valproate group.
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Affiliation(s)
- C T Ramachandraiah
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore 560029, Karnataka, India
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Sunderam S, Talathi SS, Lyubushin A, Sornette D, Osorio I. Challenges for emerging neurostimulation-based therapies for real-time seizure control. Epilepsy Behav 2011; 22:118-25. [PMID: 21664192 DOI: 10.1016/j.yebeh.2011.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 04/05/2011] [Indexed: 11/16/2022]
Abstract
In step with the worthwhile aim of this special issue, two junior investigators impart their insights on the therapeutic challenges imposed by pharmacoresistant epilepsies and offer viable approaches to improvement of treatment outcomes. Sunderam's comprehensive perspective addresses issues of critical importance for the design of efficacious therapies. Talathi delves into the thorny roles of so-called "interictal" spikes in ictio- and epileptogenesis, roles that are central to understanding the dynamics of these phenomena and implicitly of how to prevent them or abort them. First, however, Osorio and co-workers illustrate the complex behavior of the epileptogenic network and point to the importance of real-time intraindividual adaptation and optimization of therapies for seizures originating from the same epileptogenic network.
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Lucey BP, Noetzel MJ, Duntley SP. Paroxysmal arousals and myoclonic movements associated with interictal epileptiform discharges in NREM and REM sleep. Clin Neurol Neurosurg 2011; 113:419-22. [DOI: 10.1016/j.clineuro.2010.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 12/22/2010] [Accepted: 12/27/2010] [Indexed: 11/29/2022]
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Matos G, Andersen ML, do Valle AC, Tufik S. The relationship between sleep and epilepsy: Evidence from clinical trials and animal models. J Neurol Sci 2010; 295:1-7. [DOI: 10.1016/j.jns.2010.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 03/23/2010] [Accepted: 05/11/2010] [Indexed: 12/01/2022]
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Toward rational design of electrical stimulation strategies for epilepsy control. Epilepsy Behav 2010; 17:6-22. [PMID: 19926525 PMCID: PMC2818293 DOI: 10.1016/j.yebeh.2009.10.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 10/12/2009] [Indexed: 11/21/2022]
Abstract
Electrical stimulation is emerging as a viable alternative for patients with epilepsy whose seizures are not alleviated by drugs or surgery. Its attractions are temporal and spatial specificity of action, flexibility of waveform parameters and timing, and the perception that its effects are reversible unlike resective surgery. However, despite significant advances in our understanding of mechanisms of neural electrical stimulation, clinical electrotherapy for seizures relies heavily on empirical tuning of parameters and protocols. We highlight concurrent treatment goals with potentially conflicting design constraints that must be resolved when formulating rational strategies for epilepsy electrotherapy, namely, seizure reduction versus cognitive impairment, stimulation efficacy versus tissue safety, and mechanistic insight versus clinical pragmatism. First, treatment markers, objectives, and metrics relevant to electrical stimulation for epilepsy are discussed from a clinical perspective. Then the experimental perspective is presented, with the biophysical mechanisms and modalities of open-loop electrical stimulation, and the potential benefits of closed-loop control for epilepsy.
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Goncharova II, Zaveri HP, Duckrow RB, Novotny EJ, Spencer SS. Spatial distribution of intracranially recorded spikes in medial and lateral temporal epilepsies. Epilepsia 2009; 50:2575-85. [DOI: 10.1111/j.1528-1167.2009.02258.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Plante DT, Winkelman JW. Polysomnographic Features of Medical and Psychiatric Disorders and Their Treatments. Sleep Med Clin 2009. [DOI: 10.1016/j.jsmc.2009.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Many aspects of normal biological function are governed by circadian rhythms, including metabolism, ingestive behaviors, and sleep-wake cycles. Certain pathological processes as well are also affected by the circadian rhythms. For example, it is well known that seizure occurrence can be influenced by the sleep-wake cycle. The ketogenic diet (KD) is a high-fat, low-carbohydrate diet with proven efficacy in the treatment of intractable epilepsies. While the mechanisms underlying the clinical effects of the KD remain unclear, there are emerging links between circadian rhythms and KD action. Such factors should be considered when planning and administering the KD to patients.
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Affiliation(s)
- Charles N Allen
- Center for Research on Occupational and Environmental Toxicology, Oregon Health & Science University, Portland, Oregon 97239, USA.
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Alvarez-Silva I, Alvarez-Rodriguez J, Alvarez-Silva S, Perez-Echeverria MJ, Campayo-Martínez A. Melancholic major depression and epilepsy. Med Hypotheses 2007; 69:1046-53. [PMID: 17531396 DOI: 10.1016/j.mehy.2007.01.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 01/23/2007] [Indexed: 11/28/2022]
Abstract
An analysis is carried out of a set of psychic phenomena appearing always in the same way: an experience suddenly invades the consciousness, unfolding automatically and with great intensity. This psychic automatism, of which the patient is a passive observer, is accompanied by an overwhelming feeling of strangeness. Our hypothesis is that these phenomena are the expression of partial seizures with a psychic content, and the name Paroxysmal Psychic Automatisms is proposed for all of them. A comparative study is then made of the phenomenology of partial seizures with a psychic content, on the one hand, and of that of melancholic major depression, on the other. It reveals a wealth of clinical information indicating an overlap between the two conditions. Finally, a set of well-established scientific data is analysed concerning epilepsy and depression, especially epidemiological and psychopharmacological information, which takes on a new meaning in the light of the hypothesis developed in this paper.
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