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Lupo C, Fernandes M, Spanetta M, Sarbu OE, Carnovale C, Di Gioia B, Placidi F, Izzi F, Mercuri NB, Liguori C. The effect of lacosamide monotherapy on sleep architecture in patients with epilepsy: a preliminary evidence. J Neural Transm (Vienna) 2023; 130:87-95. [PMID: 36592241 DOI: 10.1007/s00702-022-02581-7] [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: 09/19/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023]
Abstract
Lacosamide (LCM) is a third-generation antiseizure medication (ASM), and its effect on sleep architecture was supported by a few studies in patients with drug-resistant epilepsy in which LCM was used as an add-on treatment. To gather knowledge on ASMs effects on sleep, this study aimed at evaluating the effects of LCM monotherapy on sleep in patients with focal epilepsy. Ten patients diagnosed with epilepsy (mean age 58.00 ± 14.77, 60.0% female, mean monthly seizure frequency 1.20 ± 2.48) starting LCM as monotherapy were included. Sleep architecture was assessed through polysomnography at baseline and at the 6-month follow-up visit. A significant decrease was observed in seizure frequency (p = 0.004), being all patients seizure-free at follow-up. At baseline, eight patients had poor sleep efficiency (< 85%). Sleep efficiency increased at follow-up, with only three patients having an index < 85% (p = 0.022). From baseline to follow-up, a significant decrease was observed in sleep latency (p = 0.022) and wakefulness after sleep onset (p = 0.047). Moreover, a significant decrease was observed in the percentage of stage 1 (Md = 6.70 vs Md = 3.85, p = 0.005) and stage 3 (Md = 27.70 vs Md = 22.35, p = 0.01) of Non-REM sleep. This study suggests that LCM monotherapy may positively impact sleep architecture in patients with epilepsy. The sleep efficiency improvement and the decrease of sleep latency and wakefulness after sleep onset observed at follow-up highlight better sleep stability and continuity in patients treated with LCM. Notably, all patients were seizure-free at follow-up, and seizure freedom may also concur to sleep structure improvement.
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Affiliation(s)
- Clementina Lupo
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome 'Tor Vergata", Rome, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome 'Tor Vergata", Rome, Italy
| | - Matteo Spanetta
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome 'Tor Vergata", Rome, Italy
| | - Oana Elena Sarbu
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome 'Tor Vergata", Rome, Italy
| | - Carola Carnovale
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome 'Tor Vergata", Rome, Italy
| | - Battista Di Gioia
- Neurology Unit, Department of Systems Medicine, Epilepsy Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome 'Tor Vergata", Rome, Italy.,Neurology Unit, Department of Systems Medicine, Epilepsy Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Francesca Izzi
- Neurology Unit, Department of Systems Medicine, Epilepsy Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, Department of Systems Medicine, Epilepsy Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome 'Tor Vergata", Rome, Italy. .,Neurology Unit, Department of Systems Medicine, Epilepsy Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
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Ye L, Xu J, Chen C, Zhang L, Wang S. Effects of anti-seizure therapies on sleep in patients with epilepsy: A literature review. Acta Neurol Scand 2022; 146:767-774. [PMID: 36071677 DOI: 10.1111/ane.13699] [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: 07/31/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022]
Abstract
Sleep disorder is common in epilepsy. With a recent rapid development in sleep medicine, it has been increasingly recognized that anti-seizure therapies, either anti-seizure medications (ASMs) or non-pharmaceutical approaches, can take direct or indirect influence on sleep in patients with epilepsy. Here, we systematically review the effect of anti-seizure treatments on sleep. ASMs targeting at different sites exerted various effects on both sleep structure and sleep quality. Non-pharmaceutical treatments including resective surgery, ketogenic diet, and transcranial magnetic stimulation appear to have a positive effect on sleep, while vagus nerve stimulation, deep brain stimulation, and brain-responsive neurostimulation are likely to interrupt sleep and exacerbate sleep-disordered breathing. The potential mechanisms underlying how non-pharmacological approaches affect sleep are also discussed. The limitation of most studies is that they were largely based on small cohorts by short-term observations. Further well-designed and large-scale investigations in this field are warranted. Understanding the effect of anti-seizure therapies on sleep can guide clinicians to optimize epilepsy treatment in the future.
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Affiliation(s)
- Lingqi Ye
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiahui Xu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Liguori C, Toledo M, Kothare S. Effects of anti-seizure medications on sleep architecture and daytime sleepiness in patients with epilepsy: A literature review. Sleep Med Rev 2021; 60:101559. [PMID: 34710770 DOI: 10.1016/j.smrv.2021.101559] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
Anti-seizure medications (ASMs) may improve or be detrimental to sleep. A literature review (as an update to the 2014 review by Jain and Glauser [https://doi.org/10.1111/epi.12478]) of 25 ASMs of interest (articles from 12 ASMs included) on the effect of ASMs/non-drug treatments on sleep in patients with epilepsy was conducted. The most common objective instrument was polysomnography, and the most common subjective measures were the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Eslicarbazepine acetate, lacosamide, and perampanel improved or had no effect on sleep. Perampanel was associated with low incidence of insomnia, and lacosamide with low incidence of daytime sleepiness adverse events. Clonazepam, felbamate, lamotrigine, oxcarbazepine, and phenobarbital worsened or had no effect on sleep. Lamotrigine may be associated with insomnia risk and phenobarbital with daytime sleepiness. Data for valproic acid were mixed. Overall, cannabidiol, carbamazepine, and levetiracetam had no effect on sleep. Epilepsy surgery may benefit sleep in patients with a good surgical outcome. Some ASMs, and, possibly, epilepsy surgery, may have positive effects on sleep, possibly linked to achieving seizure control. Nonetheless, other ASMs may worsen sleep in some settings. Clinicians should consider such observations when making treatment decisions, particularly for patients with comorbid sleep disorders.
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Affiliation(s)
- Claudio Liguori
- Epilepsy Centre, Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Manuel Toledo
- Epilepsy Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sanjeev Kothare
- Department of Pediatrics, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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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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Foldvary-Schaefer N, Neme-Mercante S, Andrews N, Bruton M, Wang L, Morrison S, Bena J, Grigg-Damberger M. Wake up to sleep: The effects of lacosamide on daytime sleepiness in adults with epilepsy. Epilepsy Behav 2017; 75:176-182. [PMID: 28866338 DOI: 10.1016/j.yebeh.2017.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the effects of lacosamide (LCM) on daytime sleepiness ascertained by the Epworth Sleepiness Scale (ESS) in adults with focal epilepsy in a randomized, controlled design. METHODS Subjects taking ≤2 AEDs for ≥4weeks underwent polysomnography with EEG followed by the maintenance of wakefulness test (MWT) and completed the ESS and other patient-reported outcomes (PROs) at baseline, LCM 200mg/day, and LCM 400mg/day (Visit 4; V4). Primary endpoint was ESS change (V4 to baseline) between LCM and placebo. Noninferiority test on ESS used a one-sided t-test based on a hypothesized difference of 4-point change between groups. Superiority test used a two-sided t-test to investigate the difference in change in PROs and MWT mean sleep latency (MSL) between groups. Fifty-five subjects provided 80% power to show noninferiority of LCM assuming 10% dropout. RESULTS Fifty-two subjects (mean age: 43.5±13.2years, 69% female, median monthly seizure frequency: 1 [0, 4.0]) participated. Baseline group characteristics including age, sex, ethnicity, standardized AED dose, seizure frequency, and ESS were similar. Abnormal baseline ESS scores were found in 35% of subjects. Noninferiority test found a ≤4-point increase in ESS (mean [95% CI]) in LCM subjects vs. placebo (-1.2 [-2.9, 0.53] vs. -1.1 [-5.2, 3.0], p=0.027) at V4. No significant difference in change in PROs, MSL, seizure frequency, or AED standardized dose was observed between groups. SIGNIFICANCE Our interventional trial found that LCM is not a major contributor to daytime sleepiness based on subjective and objective measures. Inclusion of sleepiness measures in AED trials is warranted given the high prevalence of sleep-wake complaints in people with epilepsy.
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Affiliation(s)
- Nancy Foldvary-Schaefer
- Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States; Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, OH, United States.
| | - Silvia Neme-Mercante
- Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States; Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, OH, United States
| | - Noah Andrews
- Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States
| | - Monica Bruton
- Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States
| | - Lu Wang
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States
| | - Shannon Morrison
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States
| | - James Bena
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States
| | - Madeleine Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, United States
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