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Sivathamboo S, Perucca P, Velakoulis D, Jones NC, Goldin J, Kwan P, O’Brien TJ. Sleep-disordered breathing in epilepsy: epidemiology, mechanisms, and treatment. Sleep 2018; 41:4830560. [DOI: 10.1093/sleep/zsy015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Shobi Sivathamboo
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
| | - Piero Perucca
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Department of Psychiatry, Neuropsychiatry Unit, Royal Melbourne Hospital, Victoria, Australia
| | - Nigel C Jones
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Goldin
- Department of Respiratory and Sleep Disorders Medicine, Royal Melbourne Hospital, Victoria, Australia
| | - Patrick Kwan
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Terence J O’Brien
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Dinkelacker V. Obstructive sleep apnea in drug-resistant epilepsy: A significant comorbidity warranting diagnosis and treatment. Rev Neurol (Paris) 2016; 172:361-70. [DOI: 10.1016/j.neurol.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/18/2016] [Indexed: 11/08/2022]
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Venturi M, Neves GSLM, Pontes IM, Valois A, Gomes MDM. Risk and determinant factors for obstructive sleep apnea in patients with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:924-7. [DOI: 10.1590/s0004-282x2011000700015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 07/13/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To evaluate the prevalence of risk of having obstructive sleep apnea (OSA) and its determinants in patients with epilepsy (PE). METHOD: 98 adult PE were prospectively screened for risk of OSA by Berlin questionnaire. Data was also collected about excessive daytime sleepiness, depression, anxiety, clinical and socio-demographic characteristics. RESULTS: The PE main characteristics: 59-men/39-women, mean age=39.97, SD=12.3, range 18-66. The prevalence of the risk of OSA was 55.1% (CI 95%, 0.45-0.65). The high risk for OSA was related with body mass index (BMI) (p=0.000), neck circumference (NC) (p=0.000), arterial hypertension (AH) (p=0.000), and anxiety (p=0.006), without relationship with number of seizures, number of antiepileptic drugs, age or depression. The NC was statistically significant regarding risk of OSA, mainly in men. CONCLUSION: We found a high risk of OSA in this sample. The main implicated measures were the large NC, high BMI and anxiety. The anthropometric variables were more relevant than those related to epilepsy itself and similar to those of the general population.
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Hartenbaum N, Collop N, Rosen IM, Phillips B, George CFP, Rowley JA, Freedman N, Weaver TE, Gurubhagavatula I, Strohl K, Leaman HM, Moffitt GL, Rosekind MR. Sleep Apnea and Commercial Motor Vehicle Operators:. J Occup Environ Med 2006; 48:S4-37. [PMID: 16985410 DOI: 10.1097/01.jom.0000236404.96857.a2] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Foldvary-Schaefer N, Grigg-Damberger M. Sleep and epilepsy: what we know, don't know, and need to know. J Clin Neurophysiol 2006; 23:4-20. [PMID: 16514348 DOI: 10.1097/01.wnp.0000206877.90232.cb] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Long-term video-EEG and, more recently, video-polysomnography, have provided the means to confirm and expand on the interconnections between sleep and epilepsy. Some of these relationships have become firmly established. When one of the authors (N.F.S.) presented part of this paper at a symposium on the Future of Sleep in Neurology at an American Clinical Neurophysiology Society annual meeting in 2004, the purpose was to summarize what we know, don't know, and need to know about the effects of sleep on epilepsy and epilepsy on sleep. Here we seek to summarize some of the more firmly established relationships between sleep and epilepsy and identify intriguing associations that require further elucidation.
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Abstract
OBJECTIVE To review available literature regarding weight gain associated with commonly prescribed drugs and adjunctive therapy used to limit weight gain. DATA SOURCES Information was retrieved from a MEDLINE English-literature search between 1995 and July 2005, with a major subject heading of weight gain/drug effects excluding complementary alternative medicines. Other limits applied included human subjects and individuals >19 years of age. Additionally, references from retrieved articles were reviewed to identify other literature sources. STUDY SELECTION AND DATA EXTRACTION Changes in weight are generally reported as a primary or secondary outcome of many studies. Where possible, prospective, randomized, controlled trials were preferred; however, many studies were retrospective or open label. Meta-analyses and recent reviews, especially those providing a detailed description of the proposed mechanism involved in weight gain beyond the scope of this article, were included. Limited information was available from case reports. Studies were categorized by therapeutic area including psychiatry, neurology, diabetes, and other miscellaneous drug therapy. Medications used to intentionally stimulate appetite for weight gain, such as megesterol acetate, were not included. DATA SYNTHESIS Weight gain with medication is usually associated with individual agents within a class. The tendency to cause weight gain is often related to differential specificity and sensitivity of binding to receptors involved with appetite regulation. CONCLUSIONS Clinically significant weight gain is associated with some commonly prescribed medicines. There is wide interindividual variation in response and variation of the degree of weight gain within drug classes. Where possible, alternative therapy should be selected, especially for individuals predisposed to overweight and obesity.
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Affiliation(s)
- Margaret Malone
- Department of Pharmacy Practice, Albany College of Pharmacy, NY 12208-3492, USA.
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Manni R, Terzaghi M, Arbasino C, Sartori I, Galimberti CA, Tartara A. Obstructive sleep apnea in a clinical series of adult epilepsy patients: frequency and features of the comorbidity. Epilepsia 2003; 44:836-40. [PMID: 12790898 DOI: 10.1046/j.1528-1157.2003.55702.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate the rate and features of obstructive sleep apnea (OSA) in adult epilepsy patients. METHODS Two hundred eighty-three adult epilepsy patients (137 men; mean age, 33 years; range, 18-70 years) were prospectively screened for OSA by means of a structured interview. Those in whom OSA was clinically suspected were monitored for a full night by using a portable device (Polymesam), and OSA was diagnosed when they had an Apnea/Hypopnea Index greater than five. RESULTS Coexistence of OSA with epilepsy was found in 10.2% (15.4% of the male and 5.4% of the female) epilepsy patients investigated. The OSA was mild in 66.6%, moderate in 22.2%, and severe in 11.1% of the cases. The "epilepsy + OSA" patients were older, heavier, more frequently male, and sleepier (p < 0.05) than those with "epilepsy only." Furthermore, they experienced their first seizure at an older age (p < 0.05). CONCLUSIONS Systematic investigation reveals that OSA is frequent in epilepsy patients. The major risk factors for OSA in our epilepsy patients were the same as those typically found in the general population. Of the epilepsy-related factors, older age at onset of seizures appears to be significantly related to comorbidity with OSA (p < 0.05). The presence in epilepsy patients of these features should alert the clinician to the possibility of an underlying OSA.
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Affiliation(s)
- Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, C Mondino Institute of Neurology, Pavia, Italy.
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Abstract
Obstructive sleep apnea can affect an individual with epilepsy profoundly. These relatively common disorders can coexist and potentially exacerbate each other. The identification and appropriate treatment of OSA may have far-reaching consequences in improving a patient's quality of life and recurrence of seizures. Clinicians must be aware of the relationship of these disorders and keenly question epilepsy patients, regardless of their body habitus, regarding potential symptoms of sleep apnea. Although the underlying pathogenic mechanisms are unclear, we can model the information gained from the observations to further the understanding of the relationship between sleep and epilepsy.
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Affiliation(s)
- Bradley V Vaughn
- Division of Sleep and Epilepsy, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7025, USA.
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Biton V, Levisohn P, Hoyler S, Vuong A, Hammer AE. Lamotrigine versus valproate monotherapy-associated weight change in adolescents with epilepsy: results from a post hoc analysis of a randomized, double-blind clinical trial. J Child Neurol 2003; 18:133-9. [PMID: 12693782 DOI: 10.1177/08830738030180021701] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent trends toward obesity and associated health risks in children highlight the significance of weight gain as a side effect with certain antiepilepsy drugs. No previous study has prospectively compared, in adolescents, weight effects for two commonly used antiepilepsy drugs. We report results from a post hoc subanalysis of adolescent data from a randomized, double-blind study comparing weight effects of lamotrigine and valproate. Patients were > or = 12 years of age with new-onset partial or generalized seizures who were randomized 1:1 to lamotrigine or valproate. Patients were escalated to a dose range of 100 to 500 mg/day for lamotrigine and 10 to 60 mg/kg/day for valproate based on clinical response, with target doses maintained for 24 weeks. Results are reported for adolescents aged 12 to 20 years. Weight changes during maintenance were higher (P < .05) in valproate (n = 20) patients than in lamotrigine (n = 18) patients, and change in body mass index was higher (P < .05) in valproate patients at the end of the study. At week 32, mean body mass index in the valproate group was above the 85th percentile representing "at risk for overweight." Whereas weight remained stable in adolescents treated with lamotrigine, weight increased in those treated with valproate by week 10 of this study and continued to increase at the end of the study.
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Affiliation(s)
- Victor Biton
- Arkansas Epilepsy Program, Little Rock 72205, USA.
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Ueberall MA. Normal growth during lamotrigine monotherapy in pediatric epilepsy patients -- a prospective evaluation of 103 children and adolescents. Epilepsy Res 2001; 46:63-7. [PMID: 11395290 DOI: 10.1016/s0920-1211(01)00250-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical maturation is one of the essential developmental processes during childhood and adolescence, which can be adversely affected by a number of internal and external factors. An important side effect associated with the long-term use of some antiepileptic drugs is change in body weight, followed by an increased risk for subsequent maturational problems in pediatric epilepsy patients. To evaluate the effect of lamotrigine on body growth in children and adolescents with epilepsy, weight, height and body mass index (BMI) values of 103 pediatric epilepsy patients (m/f ratio: 53/50) treated with lamotrigine monotherapy were prospectively evaluated for a period of 18.7+/-11.8 (range 6--71) months. Age at therapy introduction was 6.7+/-2.7 (range 1.6-16.4) years and daily lamotrigine dose was 7.4+/-2.2 (range 3.5--14.2) mg/kg body weight (BW). Standard deviation scores (S.D.S.) at therapy initiation versus follow-up were height -- S.D.S.: 0.07+/-0.42 versus 0.08+/-0.42 (P=n.s.); weight -- S.D.S.: -0.01+/-0.44 versus -0.01+/-0.43 (P=n.s.) and BMI -- S.D.S.: -0.24+/-0.47 versus -0.25+/-0.37 (P=n.s.). Lamotrigine long-term monotherapy was associated with normal body growth in pediatric and adolescent patients with epilepsy, regardless of patient age, gender or duration of therapy.
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Affiliation(s)
- M A Ueberall
- Neuropediatric Department, Hospital for Children and Adolescents, Friedrich-Alexander-University Erlangen-Nuernberg, Loschgestrasse 15, D-91054 Erlangen, Germany.
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Oliveira AJ, Zamagni M, Dolso P, Bassetti MA, Gigli GL. Respiratory disorders during sleep in patients with epilepsy: effect of ventilatory therapy on EEG interictal epileptiform discharges. Clin Neurophysiol 2000; 111 Suppl 2:S141-5. [PMID: 10996568 DOI: 10.1016/s1388-2457(00)00415-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Sleep disorders are common and may coexist with a variety of diseases, including epilepsy, with important implications for the clinical management of the latter. Sleep fragmentation and deprivation, and hypoxia associated to sleep disordered breathing (SDB) may contribute to the occurrence of seizures. On the other hand, antiepileptic drugs may worsen SDB by reducing the muscle tone of the upper airways, and increasing the arousal threshold. There is evidence indicating that treatment of the SDB can reduce both frequency and intensity of seizures. This study aimed at further understanding the relationship between SDB and epilepsy, particularly the influence of SDB on epileptogenicity - as evaluated by a quantitative analysis of interictal epileptogenic activity. METHODS Eight consecutive patients affected by partial epilepsy associated to SDB (OSAS or an association between chronic obstructive pulmonary disease-- COPD - and snoring) underwent two nocturnal polysomnographies (PSG)-- before and after ventilatory therapy with CPAP (in 6 patients with OSAS) or oxygen (in two patients with COPD and snoring). Spiking was quantified during the first sleep cycle in both PSG studies, and spiking rates were calculated both for the entire sleep cycle and for each separate sleep phase (NREM 1, NREM 2, NREM 3-4, REM and wake time after sleep onset - WASO). RESULTS In all patients, the improvement of the SDB after ventilatory treatment--as demonstrated by a reduction of the respiratory disturbances index (RDI) - was associated to a reduction of spiking rates, both in the entire cycle and in relationship to slow wave sleep. This reduction was particularly marked in patients with higher spiking rates in baseline conditions. CONCLUSION Our data show that SDB treatment reduces the interictal epileptogenic activity, suggesting that SDB plays a role in increasing epileptogenicity. Further studies will be necessary to clarify the mechanisms whereby this reduction in epileptogenicity occurs, although improved sleep stability seems to play an important role. The presence of an underlying SDB in patients with refractory epilepsy should be investigated.
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Affiliation(s)
- A J Oliveira
- Department of Neuroscience, Ospedale S. M. della Misericordia, 33100, Udine, Italy
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