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Strzelczyk A, Schubert-Bast S. Psychobehavioural and Cognitive Adverse Events of Anti-Seizure Medications for the Treatment of Developmental and Epileptic Encephalopathies. CNS Drugs 2022; 36:1079-1111. [PMID: 36194365 PMCID: PMC9531646 DOI: 10.1007/s40263-022-00955-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/06/2023]
Abstract
The developmental and epileptic encephalopathies encompass a group of rare syndromes characterised by severe drug-resistant epilepsy with onset in childhood and significant neurodevelopmental comorbidities. The latter include intellectual disability, developmental delay, behavioural problems including attention-deficit hyperactivity disorder and autism spectrum disorder, psychiatric problems including anxiety and depression, speech impairment and sleep problems. Classical examples of developmental and epileptic encephalopathies include Dravet syndrome, Lennox-Gastaut syndrome and tuberous sclerosis complex. The mainstay of treatment is with multiple anti-seizure medications (ASMs); however, the ASMs themselves can be associated with psychobehavioural adverse events, and effects (negative or positive) on cognition and sleep. We have performed a targeted literature review of ASMs commonly used in the treatment of developmental and epileptic encephalopathies to discuss the latest evidence on their effects on behaviour, mood, cognition, sedation and sleep. The ASMs include valproate (VPA), clobazam, topiramate (TPM), cannabidiol (CBD), fenfluramine (FFA), levetiracetam (LEV), brivaracetam (BRV), zonisamide (ZNS), perampanel (PER), ethosuximide, stiripentol, lamotrigine (LTG), rufinamide, vigabatrin, lacosamide (LCM) and everolimus. Bromide, felbamate and other sodium channel ASMs are discussed briefly. Overall, the current evidence suggest that LEV, PER and to a lesser extent BRV are associated with psychobehavioural adverse events including aggressiveness and irritability; TPM and to a lesser extent ZNS are associated with language impairment and cognitive dulling/memory problems. Patients with a history of behavioural and psychiatric comorbidities may be more at risk of developing psychobehavioural adverse events. Topiramate and ZNS may be associated with negative effects in some aspects of cognition; CBD, FFA, LEV, BRV and LTG may have some positive effects, while the remaining ASMs do not appear to have a detrimental effect. All the ASMs are associated with sedation to a certain extent, which is pronounced during uptitration. Cannabidiol, PER and pregabalin may be associated with improvements in sleep, LTG is associated with insomnia, while VPA, TPM, LEV, ZNS and LCM do not appear to have detrimental effects. There was variability in the extent of evidence for each ASM: for many first-generation and some second-generation ASMs, there is scant documented evidence; however, their extensive use suggests favourable tolerability and safety (e.g. VPA); second-generation and some third-generation ASMs tend to have the most robust evidence documented over several years of use (TPM, LEV, PER, ZNS, BRV), while evidence is still being generated for newer ASMs such as CBD and FFA. Finally, we discuss how a variety of factors can affect mood, behaviour and cognition, and untangling the associations between the effects of the underlying syndrome and those of the ASMs can be challenging. In particular, there is enormous heterogeneity in cognitive, behavioural and developmental impairments that is complex and can change naturally over time; there is a lack of standardised instruments for evaluating these outcomes in developmental and epileptic encephalopathies, with a reliance on subjective evaluations by proxy (caregivers); and treatment regimes are complex involving multiple ASMs as well as other drugs.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. .,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
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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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High prevalence of pathological alertness and wakefulness on maintenance of wakefulness test in adults with focal-onset epilepsy. Epilepsy Behav 2021; 125:108400. [PMID: 34800802 DOI: 10.1016/j.yebeh.2021.108400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a common complaint in adults with epilepsy (AWE), but objective evaluation is lacking. We used the maintenance of wakefulness test (MWT) to objectively measure the ability of adults with focal-onset epilepsy to maintain wakefulness in soporific conditions. METHODS Adults with epilepsy participating in a study investigating the effects of lacosamide on sleep and wakefulness underwent baseline ambulatory polysomnography (PSG)/EEG followed by MWT. Mean sleep latency (MSL) and mean percent sleep time (MST, mean percentage of non-wake EEG scored in 3-sec bins from lights out to sleep onset averaged over the 4 MWT trials) were quantified. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS). Spearman correlation and linear regression assessed relationships between MWT parameters, ESS and relevant sleep and epilepsy-related variables. RESULTS Maintenance of wakefulness test MSL in 51 AWE (mean age 43.5 ± 13 years, 69% female, mean BMI 24.6 ± 11.2 kg/m2) was 21.7 ± 11.9 min; 45.1% had an abnormally short MSL <19.4 min and 15.7% <8 min. MST was 9.3% [3.3, 19.1]. Mean ESS score was 8.8 ± 5.7; 39% had elevated ESS (>10). No correlation between subjective ESS and objective MSL (p = 0.67) or MST (p = 0.61) was found. MSL was significantly shorter in subjects with focal to bilateral tonic-clonic seizures (FBTCS; 7.9 min [13.6, 22.3]) compared to those without (27.4 min [21.2, 33.6], p = 0.013). Younger subjects had shorter MSL; MSL increased 3.2 min for every 10-year increase in age. CONCLUSION We found a high prevalence of objective sleepiness/difficulty maintaining wakefulness on the MWT and subjective sleepiness using the ESS in AWE without a correlation between the two. More severe objective sleepiness was found in subjects with a history of FBTCS and younger age. Further research is needed to determine mechanistic underpinnings and optimal measurements of pathological sleepiness in people with epilepsy given the burden of it on quality of life.
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Nobili L, Beniczky S, Eriksson SH, Romigi A, Ryvlin P, Toledo M, Rosenzweig I. Expert Opinion: Managing sleep disturbances in people with epilepsy. Epilepsy Behav 2021; 124:108341. [PMID: 34619543 DOI: 10.1016/j.yebeh.2021.108341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022]
Abstract
Poor sleep and daytime sleepiness are common in people with epilepsy. Sleep disorders can disrupt seizure control and in turn sleep and vigilance problems can be exacerbated by seizures and by antiepileptic treatments. Nevertheless, these aspects are frequently overlooked in clinical practice and a clear agreement on the evidence-based guidelines for managing common sleep disorders in people with epilepsy is lacking. Recently, recommendations to standardize the diagnostic pathway for evaluating patients with sleep-related epilepsies and comorbid sleep disorders have been presented. To build on these, we adopted the Delphi method to establish a consensus within a group of experts and we provide practical recommendations for identifying and managing poor night-time sleep and daytime sleepiness in people with epilepsy. We recommend that a comprehensive clinical history of sleep habits and sleep hygiene should be always obtained from all people with epilepsy and their bed partners. A psychoeducational approach to inform patients about habits or practices that may negatively influence their sleep or their vigilance levels should be used, and strategies for avoiding these should be applied. In case of a suspected comorbid sleep disorder an appropriate diagnostic investigation should be performed. Moreover, the possible presence of sleep fragmentation induced by sleep-related seizures should be ruled out. Finally, the dose and timing of antiepileptic medications and other co-medications should be optimized to improve nocturnal sleep and avoid daytime sedation.
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Affiliation(s)
- Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy; Child Neuropsychiatry Unit, Istituto G. Gaslini, Genoa, Italy.
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre and Aarhus University Hospital, Denmark.
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK.
| | | | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaud University Hospital Center, Lausanne, Switzerland
| | - Manuel Toledo
- Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Kings College London and Sleep Disorders Centre, GSTT NHS Trust, London, UK.
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Sleep quality and daytime sleepiness in epilepsy: Systematic review and meta-analysis of 25 studies including 8,196 individuals. Sleep Med Rev 2021; 57:101466. [PMID: 33838598 DOI: 10.1016/j.smrv.2021.101466] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/26/2022]
Abstract
We sought to gain a better understanding of the relationship between epilepsy and sleep quality and daytime sleepiness by performing a literature search of PubMed for case-control studies that compared patients with epilepsy to controls and reported the Pittsburgh sleep quality index (PSQI) and/or the Epworth sleepiness scale (ESS). Study-specific mean differences in the PSQI and ESS between cases and controls were extracted from the publications and pooled using random-effects meta-analysis. Twenty-five studies (2964 cases, 5232 controls) were included. Fifteen studies reported the PSQI and 24 the ESS. Mean age was 40 years; 50.4% were women. When comparing cases to controls, the pooled mean differences in the PSQI and ESS were 1.27 (95% confidence interval (CI): 0.76, 1.78; P < 0.001; I2: 81.4%) and 0.38 (95% CI: -0.07, 0.84; P = 0.099; I2: 81.0%). Subgroup analyses revealed that mean differences in the ESS were significantly lower in studies with a higher proportion of patients with focal epilepsy (P = 0.004). In this large-scale meta-analysis patients with epilepsy had a higher PSQI, close to the pathological cut-off, compared to controls, but a similar and unremarkable ESS. Further studies are needed to investigate potential effect modifiers, such as specific antiepileptic drugs or seizure frequency.
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Effects of eslicarbazepine as add-on therapy on sleep architecture in temporal lobe epilepsy: results from “Esleep” study. Sleep Med 2020; 75:287-293. [DOI: 10.1016/j.sleep.2020.06.033] [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: 04/17/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 01/31/2023]
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Grigg-Damberger M, Andrews N, Wang L, Bena J, Foldvary-Schaefer N. Subjective and objective hypersomnia highly prevalent in adults with epilepsy. Epilepsy Behav 2020; 106:107023. [PMID: 32213453 DOI: 10.1016/j.yebeh.2020.107023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Sleepiness is among the most common complaints of people with epilepsy, but objective documentation is lacking. We systematically investigated subjective and objective sleepiness in an observational cross-sectional cohort of adults with epilepsy (AWE). METHODS This is a prospective study of AWE consecutively recruited without foreknowledge of sleep/wake complaints. Polysomnography (PSG) with 18-channel electroencephalography (EEG) followed by multiple sleep latency testing (MSLT) was performed. Patients completed the Epworth Sleepiness Scale (ESS), a single-item question assessing excessive daytime sleepiness (EDS), and a 7-day sleep and seizure diary. Multivariable linear models were used to assess the association between MSLT mean sleep latency (MSL) and interests with adjustment of covariates of interest. Receiver operating characteristics (ROC) analysis was performed to evaluate the discrimination capability of ESS on MSL < 8 min and <5 min and investigate the optimal cutpoints. RESULTS Among 127 AWE (mean age: 38.7 ± 13.7 years), abnormal MSL (<8 min) was observed in 49.6% and MSL <5 min in 31.5%. While 78% reported feeling sleepy during the day on a single-item question, only 24% had elevated scores on the ESS (>10/24). The ESS score was associated with MSL even after adjusting for seizure frequency, antiseizure medication (ASM) standardized dose and number, age, gender, depression and insomnia symptom severity, and apnea-hypopnea index (HPI) and total sleep time on PSG (coefficients [95% confidence interval (CI)]: -0.26 [-0.48, -0.05], p = 0.018). The area under the curve (AUC) of the ESS ROC predicting MSL < 8 min and MSL < 5 min were similar: 0.62 (95%CI: 0.52-0.72) and 0.62 (95%CI: 0.51-0.74). CONCLUSIONS This is the largest prospective cross-sectional observational study to date using MSLT in AWE. We found subjective and objective daytime sleepiness highly prevalent in AWE and not explained by seizure frequency, ASM burden, symptoms of insomnia/depression, or PSG findings although those with MSL < 5 min were more likely to have obstructive sleep apnea (OSA). Pathologic sleepiness with MSL < 8 min was present in half of AWE. Nearly one-third of AWE unselected for sleep/wake complaints had MSL < 5 min, a range typical of narcolepsy.
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Affiliation(s)
- Madeleine Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | - Noah Andrews
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America
| | - Lu Wang
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - James Bena
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - Nancy Foldvary-Schaefer
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America.
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Wang YQ, Zhang MQ, Li R, Qu WM, Huang ZL. The Mutual Interaction Between Sleep and Epilepsy on the Neurobiological Basis and Therapy. Curr Neuropharmacol 2018; 16:5-16. [PMID: 28486925 PMCID: PMC5771383 DOI: 10.2174/1570159x15666170509101237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/11/2017] [Accepted: 04/27/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sleep and epilepsy are mutually related in a complex, bidirectional manner. However, our understanding of this relationship remains unclear. RESULTS The literatures of the neurobiological basis of the interactions between sleep and epilepsy indicate that non rapid eye movement sleep and idiopathic generalized epilepsy share the same thalamocortical networks. Most of neurotransmitters and neuromodulators such as adenosine, melatonin, prostaglandin D2, serotonin, and histamine are found to regulate the sleep-wake behavior and also considered to have antiepilepsy effects; antiepileptic drugs, in turn, also have effects on sleep. Furthermore, many drugs that regulate the sleep-wake cycle can also serve as potential antiseizure agents. The nonpharmacological management of epilepsy including ketogenic diet, epilepsy surgery, neurostimulation can also influence sleep. CONCLUSION In this paper, we address the issues involved in these phenomena and also discuss the various therapies used to modify them.
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Affiliation(s)
| | | | - Rui Li
- Department of Pharmacology and Shanghai Key Laboratory of Bioactive Small Molecules, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation
Center for Brain Science, Fudan University, Shanghai200032, P.R. China
| | - Wei-Min Qu
- Department of Pharmacology and Shanghai Key Laboratory of Bioactive Small Molecules, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation
Center for Brain Science, Fudan University, Shanghai200032, P.R. China
| | - Zhi-Li Huang
- Department of Pharmacology and Shanghai Key Laboratory of Bioactive Small Molecules, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation
Center for Brain Science, Fudan University, Shanghai200032, P.R. China
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Romigi A, Izzi F, Liguori C, Bove L, Pisani A, Placidi F, Mercuri NB. Effects of adjunctive perampanel on sleep quality, daytime somnolence and cognition in refractory focal epilepsy: further data. Epilepsy Behav 2017; 67:137-138. [PMID: 28109779 DOI: 10.1016/j.yebeh.2016.10.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Affiliation(s)
- A Romigi
- University of Rome Tor Vergata, Neurophysiopathology Department, Rome, Italy; San Giovanni Addolorata General Hospital, Department of Neurology Epilepsy Center, Via dell''Amba Aradam 9, 00184 Rome, Italy.
| | - F Izzi
- University of Rome Tor Vergata, Neurophysiopathology Department, Rome, Italy
| | - C Liguori
- University of Rome Tor Vergata, Neurophysiopathology Department, Rome, Italy
| | - L Bove
- San Giovanni Addolorata General Hospital, Department of Neurology Epilepsy Center, Via dell''Amba Aradam 9, 00184 Rome, Italy
| | - A Pisani
- University of Rome Tor Vergata, Neurophysiopathology Department, Rome, Italy
| | - F Placidi
- University of Rome Tor Vergata, Neurophysiopathology Department, Rome, Italy
| | - N B Mercuri
- University of Rome Tor Vergata, Neurophysiopathology Department, Rome, Italy; Fondazione Santa Lucia, Via Ardeatina 306, Rome, Italy
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Abstract
Sleep disorders are common in neurology practice, but are often undiagnosed and untreated. Specific patient cohorts, such as older adults, patients residing in nursing homes, and patients with underlying chronic neurologic and psychiatric disorders, are at particular risk. If these sleep problems are not properly evaluated and managed the patient may experience exacerbation of the underlying neurologic disorder. This article highlights some of the key sleep disorders relevant to practicing neurologists, emphasizing hypersomnolence, insomnia, and sleep-related movement disorders in the setting of neurologic disorders to enhance the tools available for evaluation, and discusses management strategies.
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Affiliation(s)
- Lori Ani Panossian
- Sleep Laboratory, East Bay Division, Department of Neurology, Veterans Affairs Northern California Health Care System, 150 Muir Road, Martinez, CA 94553, USA
| | - Alon Y Avidan
- Department of Neurology, UCLA Sleep Disorders Center, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, Room 1-145 RNRC, Los Angeles, CA 90095-1769, USA.
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Shimura A, Takaesu Y, Aritake S, Futenma K, Komada Y, Inoue Y. Later sleep schedule and depressive symptoms are associated with usage of multiple kinds of hypnotics. Sleep Med 2016; 25:56-62. [PMID: 27823717 DOI: 10.1016/j.sleep.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Usage of high doses of hypnotics possibly causes various adverse events. However, the risk factors of using multiple kinds of hypnotics have been inconclusive. To clarify this, we conducted a web-based cross-sectional questionnaire survey on the Japanese adult population. METHODS A cross-sectional Internet-linked survey was conducted on 10,016 individuals and 1030 participants (10.3%) having subjective insomnia proceeded to subsequent analyses. The analyzed subjects were categorized into non-users of hypnotics (n = 833; 80.9%), users of a single kind of hypnotic (n = 96; 9.3%), and users of multiple kinds of hypnotics (n = 101; 9.8%). The descriptive variables including demographic data, scores of Center for Epidemiological Studies Depression Scale (CES-D), Short Form-8 Health-Related Quality of Life [QOL (SF-8)], Pittsburgh Sleep Quality Index (PSQI), and other parameters were compared among the groups. RESULTS The users of multiple kinds of hypnotics had the highest mean score of CES-D, the lowest mental component summary of QOL (SF-8), and the latest sleep schedule among the three groups (p < 0.001). Logistic regression analyses revealed that sex (female: OR = 2.38; p < 0.001) and age (≥43 years old: OR = 2.61; p < 0.001) were independently associated with use of a single kind of hypnotic, while later sleep schedule (midpoint of sleep ≥5:30 a.m.: OR = 2.26; p < 0.001) and higher CES-D score (≥16 points: OR = 2.41; p < 0.001) were independently associated with use of multiple kinds of hypnotics. CONCLUSIONS Characteristics of users of multiple kinds of hypnotics were different from those of users of a single kind of hypnotic.
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Affiliation(s)
- Akiyoshi Shimura
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan; Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | | | - Sayaka Aritake
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kunihiro Futenma
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan; Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Yoko Komada
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yuichi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan; Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.
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Joshi RB, Gaspard N, Goncharova II, Pavlova M, Duckrow RB, Gerrard JL, Spencer DD, Hirsch LJ, Zaveri HP. Progressive change in sleep over multiple nights of intracranial EEG monitoring. Clin Neurophysiol 2016; 127:2302-7. [DOI: 10.1016/j.clinph.2016.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/31/2016] [Accepted: 02/23/2016] [Indexed: 12/17/2022]
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Romigi A, Femia EA, Fattore C, Vitrani G, Di Gennaro G, Franco V. Zonisamide in the management of epilepsy in the elderly. Clin Interv Aging 2015; 10:931-7. [PMID: 26089654 PMCID: PMC4467644 DOI: 10.2147/cia.s50819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Zonisamide (ZNS), a second-generation antiepileptic drug, indicated as add-on treatment of focal epilepsy, has been recently approved as monotherapy for the treatment of partial seizures in adults affected by newly diagnosed epilepsy in Europe. Evidence on the efficacy and tolerability of antiepileptic drugs in the elderly is still lacking as these patients are frequently excluded from clinical trials. Here, a comprehensive overview of available data regarding the use of ZNS in the treatment of epilepsy in elderly people is provided. In a pooled analysis conducted in patients aged ≥65 years, no new/unexpected safety findings have emerged. Few data from uncontrolled investigations suggest that ZNS may be effective and well tolerated when administered as monotherapy or adjunctive antiepileptic treatment in the elderly. However, evidence from these observational studies is less than satisfactory, and randomized controlled trials focused on these patients are still needed.
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Affiliation(s)
- Andrea Romigi
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Pozzilli (IS), Italy
- Neurophysiopathology Department, University of Rome Tor Vergata, Rome, Italy
| | - Eti A Femia
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Cinzia Fattore
- Clinical Trial Centre & Antiepileptic Drugs, C. Mondino National Neurological Institute, Pavia, Italy
| | - Giuseppe Vitrani
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Valentina Franco
- Clinical Trial Centre & Antiepileptic Drugs, C. Mondino National Neurological Institute, Pavia, Italy
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Romigi A, Izzi F, Mercuri NB, Albanese M, Liguori C, Placidi F. Effects of epilepsy treatment on sleep architecture and daytime sleepiness: An evidence‐based review of objective sleep metrics. Epilepsia 2014; 55:777-778. [DOI: 10.1111/epi.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Romigi
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Francesca Izzi
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Nicola B. Mercuri
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
- IRCCS Santa Lucia Foundation Rome Italy
| | - Maria Albanese
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Claudio Liguori
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Fabio Placidi
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
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Jain SV, Glauser TA. Effects of epilepsy treatments on sleep architecture and daytime sleepiness: An evidence-based review of objective sleep metrics. Epilepsia 2013; 55:26-37. [DOI: 10.1111/epi.12478] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Sejal V. Jain
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Tracy A. Glauser
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
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Sleep and epilepsy. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:483248. [PMID: 24236231 PMCID: PMC3819916 DOI: 10.1155/2013/483248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/18/2022]
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A Clinical-EEG Study of Sleepiness and Psychological Symptoms in Pharmacoresistant Epilepsy Patients Treated with Lacosamide. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:593149. [PMID: 24171111 PMCID: PMC3792514 DOI: 10.1155/2013/593149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/01/2013] [Accepted: 08/05/2013] [Indexed: 11/24/2022]
Abstract
Our aim was to evaluate the EEG and clinical modifications induced by the new antiepileptic drug lacosamide (LCM) in patients with epilepsy. We evaluated 10 patients affected by focal pharmacoresistant epilepsy in which LCM (mean 250 mg/day) was added to the preexisting antiepileptic therapy, which was left unmodified. Morning waking EEG recording was performed before (t0) and at 6 months (t1) after starting LCM. At t0 and t1, patients were also administered questionnaires evaluating mood, anxiety, sleep, sleepiness, and fatigue (Beck Depression Inventory; State-Trait Anxiety Inventory Y1 and Y2; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Fatigue Severity Scale). We performed a quantitative analysis of EEG interictal abnormalities and background EEG power spectrum analysis. LCM as an add-on did not significantly affect anxiety, depression, sleepiness, sleep quality, and fatigue scales. Similarly, adding LCM to preexisting therapy did not modify significantly patient EEGs in terms of absolute power, relative power, mean frequency, and interictal abnormalities occurrence. In conclusion, in this small cohort of patients, we confirmed that LCM as an add-on does not affect subjective parameters which play a role, among others, in therapy tolerability, and our clinical impression was further supported by evaluation of EEG spectral analysis.
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Epilepsy, antiseizure therapy, and sleep cycle parameters. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:670682. [PMID: 23997949 PMCID: PMC3749600 DOI: 10.1155/2013/670682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/04/2013] [Accepted: 07/18/2013] [Indexed: 01/16/2023]
Abstract
A reciprocal relationship exists between sleep and epilepsy. The quality of sleep is affected by the presence and frequency of seizures, type of antiepileptic therapy utilized, and coexisting primary sleep disorders. Daytime somnolence is one of the most common adverse effects of antiepileptic therapy, with specific pharmacologic agents exhibiting a unique influence on components of sleep architecture. The newer generation of antiseizure drugs demonstrates improved sleep efficiency, greater stabilization of sleep architecture, prolongation of REM sleep duration, and increased quality of life measures. The emerging field of chronoepileptology explores the relationship between seizures and circadian rhythms, aiming for targeted use of antiseizure therapies to maximize therapeutic effects and minimize the adverse events experienced by the patients.
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Hoy SM. Zonisamide: A Review of Its Use in the Management of Adults with Partial Seizures. Drugs 2013; 73:1321-38. [DOI: 10.1007/s40265-013-0093-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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