Insomnia and poor sleep quality are associated with poor seizure control in patients with epilepsy

Clinical Spectrum and Trajectory of Innovative Therapeutic Interventions for Insomnia: A Perspective

Increasing incidences of insomnia in adults, as well as the aging population, have been reported for their negative impact on the quality of life. Insomnia episodes may be associated with neurocognitive, musculoskeletal, cardiovascular, gastrointestinal, renal, hepatic, and metabolic disorders. Epidemiological evidence also revealed the association of insomnia with oncologic and asthmatic complications, which has been indicated as bidirectional. Two therapeutic approaches including cognitive behavioral therapy (CBT) and drugs-based therapies are being practiced for a long time. However, the adverse events associated with drugs limit their wide and long-term application. Further, Traditional Chinese medicine, acupressure, and pulsed magnetic field therapy may also provide therapeutic relief. Notably, the recently introduced cryotherapy has been demonstrated as a potential candidate for insomnia which could reduce pain, by suppressing oxidative stress and inflammation. It seems that the synergistic therapeutic approach of cryotherapy and the above-mentioned approaches might offer promising prospects to further improve efficacy and safety. Considering these facts, this perspective presents a comprehensive summary of recent advances in pathological aetiologies of insomnia including COVID-19, and its therapeutic management with a greater emphasis on cryotherapy.

Orexin receptor antagonists in the pathophysiology and treatment of sleep disorders and epilepsy

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.

[Alternative methods of therapy for comorbid sleep disorders as a method of choice in adult patients with epilepsy]

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.

[The impact of antiepileptic therapy on sleep disorders in women with epilepsy]

OBJECTIVE

To analyze the frequency of various sleep disorders in patients with epilepsy receiving antiepileptic therapy.

MATERIAL AND METHODS

Sixty-four women were selected from the register of patients with epilepsy and other paroxysmal conditions. The group consisted of young and middle-aged women (36.9±13.5 years), all patients received antiepileptic therapy. To diagnose sleep disorders, we used a sequential algorithm for clinical examination supplemented by instrumental methods according to indications (polysomnography, respiratory monitoring).

RESULTS

The duration of epilepsy was 15.7±7.6 years, the disease was represented by three forms: structural (n=15, 23.4%), genetic (n=32, 50%) and unspecified (n=17, 26.6%). Sleep disorders were common among female patients with epilepsy (43.7%), they are most frequently combined with genetic epilepsy (18.7%), and represented by: insomnia (43%) mild to moderately severe breathing disorders (32%) and sleep movement disorders (25%). Sleep disorders were combined with symptoms of depression in the majority of patients (71%). A 6-month follow-up evaluation of nighttime sleep parameters after treatment showed a decrease in the frequency of sleep disorders to 25%; scores on the Epworth Sleepiness Scale significantly decreased to 6.7±3.6. A change in antiepileptic therapy in patients with sleep breathing disorders resulted in a marked regression of the Apnea-Hypopnea Index (9.2±2.5 points; p=0.003). However, there were no significant changes in the severity of sleep movement disorders.

CONCLUSION

Sleep disorders are common in patients with epilepsy, in most cases they are associated with mood disorders, and may regress after optimization of antiepileptic therapy.

Sleep Disruption Worsens Seizures: Neuroinflammation as a Potential Mechanistic Link

Sleep disturbances, such as insomnia, obstructive sleep apnea, and daytime sleepiness, are common in people diagnosed with epilepsy. These disturbances can be attributed to nocturnal seizures, psychosocial factors, and/or the use of anti-epileptic drugs with sleep-modifying side effects. Epilepsy patients with poor sleep quality have intensified seizure frequency and disease progression compared to their well-rested counterparts. A better understanding of the complex relationship between sleep and epilepsy is needed, since approximately 20% of seizures and more than 90% of sudden unexpected deaths in epilepsy occur during sleep. Emerging studies suggest that neuroinflammation, (e.g., the CNS immune response characterized by the change in expression of inflammatory mediators and glial activation) may be a potential link between sleep deprivation and seizures. Here, we review the mechanisms by which sleep deprivation induces neuroinflammation and propose that neuroinflammation synergizes with seizure activity to worsen neurodegeneration in the epileptic brain. Additionally, we highlight the relevance of sleep interventions, often overlooked by physicians, to manage seizures, prevent epilepsy-related mortality, and improve quality of life.