The relationship between epileptic seizure and melatonin in children

Continuous Spike-Waves during Slow Sleep Today: An Update

In the context of childhood epilepsy, the concept of continuous spike-waves during slow sleep (CSWS) includes several childhood-onset heterogeneous conditions that share electroencephalograms (EEGs) characterized by a high frequency of paroxysmal abnormalities during sleep, which have negative effects on the cognitive development and behavior of the child. These negative effects may have the characteristics of a clear regression or of a slowdown in development. Seizures are very often present, but not constantly. The above makes it clear why CSWS have been included in epileptic encephalopathies, in which, by definition, frequent EEG paroxysmal abnormalities have an unfavorable impact on cognitive functions, including socio-communicative skills, causing autistic features, even regardless of the presence of clinically overt seizures. Although several decades have passed since the original descriptions of the electroclinical condition of CSWS, there are still many areas that are little-known and deserve to be further studied, including the EEG diagnostic criteria, the most effective electrophysiological parameter for monitoring the role of the thalamus in CSWS pathogenesis, its long-term evolution, the nosographic location of Landau-Kleffner syndrome, standardized neuropsychological and behavioral assessments, and pharmacological and non-pharmacological therapies.

Effect of melatonin on sleep quality and EEG features in childhood epilepsy: a possible non-conventional treatment

Background

Sleep and epilepsy are characterized by a bidirectional relationship. Indeed, epilepsy predisposes to the development of sleep disorders, while sleep deprivation may exacerbate epilepsy. In addition, antiseizure medication can disrupt normal sleep architecture. Therefore, adequate sleep hygiene could lead to improvement in seizure control. The present study aimed to evaluate the effect of melatonin on seizure frequency, EEG tracing, and sleep in children with focal idiopathic epilepsy.

Methods

This observation study evaluated the effect of 4 mg oral melatonin in ameliorating sleep-wake cycle, seizure frequency, and EEG features in children with focal idiopathic epilepsy of infancy. Twenty children were enrolled from September 2020 to August 2021. The study consisted of serial controls at enrollment (t0), at 3 months (t1), and at 6 months (t2) including neurological examination, questionnaire about sleep disturbances (CSHQ), and EEG.

Results

A significant improvement in sleep quality and daytime sleepiness was observed after melatonin supplementation. Furthermore, we observed a noteworthy improvement in EEG tracing at t2 that exhibited a significant correlation with improvements in CSHQ scores.

Conclusion

The studies conducted so far to evaluate the effect of melatonin in persons with epilepsy do not lead to definitive conclusions. Despite the small population sample and the study design, we report sleep and EEG improvement after melatonin administration in our cohort. Larger studies are needed to further study the neuroprotective and anticonvulsant properties of melatonin.

Serum Levels of Neuropeptides in Epileptic Encephalopathy With Spike-and-Wave Activation in Sleep

BACKGROUND

Epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) is a syndrome of childhood, characterized by diffuse or generalized spike-wave activity in electroencephalography during non-rapid eye movement sleep. Neuropeptides have been demonstrated in several studies to function in the sleep-wake cycle and display convulsant and anticonvulsant features. In this study, we aimed to investigate the relationship between EE-SWAS and neuropeptides such as dynorphin, galanin, ghrelin, leptin, melatonin, and orexin.

METHODS

This multicenter study was conducted from July 2019 to January 2021. There were three groups: Group 1 contained patients with EE-SWAS. Group 2 consisted of patients with self-limited focal epilepsy of childhood (SeLFE), and group 3 was the control group. Levels of neuropeptides were compared in the sera of these three groups.

RESULTS

There were 59 children aged between four and 15 years. Group 1 contained 14 children, group 2 contained 24 children, and group 3 contained 21 children. The level of leptin is higher and the level of melatonin is lower in group 1 than in group 3 (P = 0.01 and P = 0.005, respectively). In group 3, the level of orexin was lower than in both groups 2 and 3 (P = 0.01 and P = 0.01).

CONCLUSIONS

These data show that the level of leptin was higher and the level of melatonin was lower in patients with EE-SWAS than in the control group. Furthermore, patients with EE-SWAS had lower orexin levels than both the control group and patients with SeLFE. Further research is required to understand the potential role of these neuropeptides in the pathophysiology of EE-SWAS.

Effect of add-on melatonin on seizure outcomes and quality of sleep in epilepsy with idiopathic generalized tonic-clonic seizures alone in adult patients: Cross-sectional, randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Effective treatment of epilepsy is a major challenge in the field of neurology. Studies have suggested that melatonin can work in epilepsy with a good safety profile.

OBJECTIVES

This study was performed to determine the effectiveness of melatonin in seizure outcomes, as well as the quality of sleep in patients with generalized epilepsy.

METHODS

In this cross-over clinical trial study, 60 patients with epilepsy with idiopathic generalized tonic-clonic seizures alone (EGTCS) and under valproic acid treatment received either melatonin or placebo with a washout period of 2 weeks intermittently. Outcome variables included a reduction in the severity and frequency of epilepsy besides improvement in electroencephalogram (EEG) abnormalities and sleep quality.

RESULTS

By adding melatonin, a decrease in the mean severity score of epilepsy (according to the Chalfont questionnaire) was 32.33 ± 9.24, while it was 5.58 ± 14.28 in treatment with placebo (p = .002). Evaluation of the number of attacks and EEG results did not disclose any therapeutic efficacy in treatment with melatonin versus placebo. The quality of sleep improved in 40% (first round) and 53.4% (second round) of subjects who received melatonin (p < .001).

CONCLUSIONS

Considering that the addition of melatonin to routine anti-seizure treatment was effective in reducing the severity of epilepsy and improving sleep quality, it seems that melatonin can be useful as an adjunct therapy for EGTCS in well-defined circumstances.

Adverse events in long-term studies of exogenous melatonin

INTRODUCTION

Exogenous melatonin is regulated as a drug in the UK and EU but is available as an over-the-counter dietary supplement in the US and Canada. In the last 15 years, melatonin use has increased rapidly in many countries, in particular, in children and adolescents who frequently have many years of continuous exposure. Despite this, the potential risks associated with extended use continue to be unclear, and there remains a lack of systematically assessed safety data from long-term prospective trials.

AREAS COVERED

This review focuses on adverse event data reported in long-term (≥6 months) prospective trials of melatonin.

METHODS

The Embase and Medline electronic databases were searched from inception to 12 September 2022 for long-term studies of melatonin, in which adverse events were systematically monitored and reported.

EXPERT OPINION

Although the reported frequency of possible adverse events associated with long-term melatonin use is low and few clinically significant adverse events have been reported, the scarcity of data from double-blind randomized placebo-controlled trials should caution against complacency. Ideally, analysis of data from large well-established research databases should be conducted to provide good quality evidence on which to base a more rigorous evaluation of the safety profile.