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Lah S, Karapetsas G, Winsor A, Gonzalez L, Mandalis A, Pertini M, Gascoigne M. Sleep and functional outcomes in children and adolescents with epilepsy: A scoping review. Seizure 2024; 120:89-103. [PMID: 38924846 DOI: 10.1016/j.seizure.2024.06.006] [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: 03/31/2024] [Revised: 05/24/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
AIM In children and adolescents with epilepsy (CAWE), disturbed sleep and functional difficulties are frequently present, but their relationship is unclear. In this scoping review we aimed to explore associations between sleep and functional outcomes in CAWE. METHOD We registered the protocol with open science framework and conducted the review according to the PRISMA Extension for Scoping Reviews. We searched Medline, Embase, PsycINFO and PubMed for original studies reporting on relations between sleep and functional outcomes (adaptive/quality of life, behavioural/mood, cognitive & academic) in CAWE. To assess the quality of studies we used an extended version of the checklist employed by Winsor and colleagues [1]. RESULTS We identified 14 studies that included 1,785 CAWE and 1,260 control children, with a mean age of 9.94 and 10.13 years, respectively. The studies were highly heterogeneous with respect to samples, epilepsy variables, and methods used to assess sleep and functional outcomes. The quality of studies was medium. Associations between sleep and adaptive/quality of life, behavioural/mood, cognitive and academic outcomes were examined in 2, 10, 6, and 0 studies, respectively. Across studies, in CAWE, greater sleep disturbances were related to worse behavioural/mood outcomes, ranging from depression/anxiety to ADHD symptoms. Sleep disturbances did not consistently relate to cognitive outcomes, but they related to worse adaptive outcomes in both studies that examined their relationship. CONCLUSIONS Our study provides evidence of relationship between disturbed sleep and behavioural/mood difficulties, which alerts to the need for careful evaluation and treatment of sleep disturbances in CAWE. Our study also highlights the need to examine relationships between sleep and other functional outcomes in CAWE, as studies conducted in the general population suggest that sleep disturbances may be modifiable and associated with improved functional outcomes.
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Affiliation(s)
- Suncica Lah
- School of Psychology, University of Sydney, Sydney, Australia; Australian Paediatric Neuropsychology Research Network, Australia.
| | - George Karapetsas
- Australian Paediatric Neuropsychology Research Network, Australia; Macquarie University, Macquarie Park, New South Wales, Australia
| | - Alice Winsor
- Maurice Wohl clinical neuroscience institute, kings college London, United Kingdom
| | - Linda Gonzalez
- Australian Paediatric Neuropsychology Research Network, Australia; Matrix Neuropsychology Melbourne, Australia and University of Melbourne, Parkville, Victoria, Australia
| | - Anna Mandalis
- Australian Paediatric Neuropsychology Research Network, Australia; Sydney Children's Hospital Randwick, Sydney Australia
| | - Mark Pertini
- Australian Paediatric Neuropsychology Research Network, Australia; Consultation Liaison Service, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael Gascoigne
- Australian Paediatric Neuropsychology Research Network, Australia; School of Psychology & Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
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Proost R, Heremans E, Lagae L, Van Paesschen W, De Vos M, Jansen K. Automated sleep staging on reduced channels in children with epilepsy. Front Neurol 2024; 15:1390465. [PMID: 38798709 PMCID: PMC11116721 DOI: 10.3389/fneur.2024.1390465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives This study aimed to validate a sleep staging algorithm using in-hospital video-electroencephalogram (EEG) in children without epilepsy, with well-controlled epilepsy (WCE), and with drug-resistant epilepsy (DRE). Methods Overnight video-EEG, along with electrooculogram (EOG) and chin electromyogram (EMG), was recorded in children between 4 and 18 years of age. Classical sleep staging was performed manually as a ground truth. An end-to-end hierarchical recurrent neural network for sequence-to-sequence automatic sleep staging (SeqSleepNet) was used to perform automated sleep staging using three channels: C4-A1, EOG, and chin EMG. Results In 176 children sleep stages were manually scored: 47 children without epilepsy, 74 with WCE, and 55 with DRE. The 5-class sleep staging accuracy of the automatic sleep staging algorithm was 84.7% for the children without epilepsy, 83.5% for those with WCE, and 80.8% for those with DRE (Kappa of 0.79, 0.77, and 0.73 respectively). Performance per sleep stage was assessed with an F1 score of 0.91 for wake, 0.50 for N1, 0.83 for N2, 0.84 for N3, and 0.86 for rapid eye movement (REM) sleep. Conclusion We concluded that the tested algorithm has a high accuracy in children without epilepsy and with WCE. Performance in children with DRE was acceptable, but significantly lower, which could be explained by a tendency of more time spent in N1, and by abundant interictal epileptiform discharges and intellectual disability leading to less recognizable sleep stages. REM sleep time, however, significantly affected in children with DRE, can be detected reliably by the algorithm.Clinical trial registration: ClinicalTrials.gov, identifier NCT04584385.
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Affiliation(s)
- Renee Proost
- Pediatric Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Elisabeth Heremans
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Lieven Lagae
- Pediatric Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Maarten De Vos
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Katrien Jansen
- Pediatric Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Türkyılmaz A, Sağer SG, Tekin E, Teralı K, Düzkalır H, Eser M, Akın Y. Expanding the clinical and genetic landscape of (developmental) epileptic encephalopathy with spike-and-wave activation in sleep: results from studies of a Turkish cohort. Neurogenetics 2024; 25:119-130. [PMID: 38388889 DOI: 10.1007/s10048-024-00751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
The terms developmental epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS) and epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) designate a spectrum of conditions that are typified by different combinations of motor, cognitive, language, and behavioral regression linked to robust spike-and-wave activity during sleep. In this study, we aimed at describing the clinical and molecular findings in "(developmental) epileptic encephalopathy with spike-and-wave activation in sleep" (D)EE-SWAS) patients as well as at contributing to the genetic etiologic spectrum of (D)EE-SWAS. Single nucleotide polymorphism (SNP) array and whole-exome sequencing (WES) techniques were used to determine the underlying genetic etiologies. Of the 24 patients included in the study, 8 (33%) were female and 16 (67%) were male. The median age at onset of the first seizure was 4 years and the median age at diagnosis of (D)EE-SWAS was 5 years. Of the 24 cases included in the study, 13 were compatible with the clinical diagnosis of DEE-SWAS and 11 were compatible with the clinical diagnosis of EE-SWAS. Abnormal perinatal history was present in four cases (17%), and two cases (8%) had a family history of epilepsy. Approximately two-thirds (63%) of all patients had abnormalities detected on brain computerized tomography/magnetic resonance (CT/MR) imaging. After SNP array and WES analysis, the genetic etiology was revealed in 7 out of 24 (29%) cases. Three of the variants detected were novel (SLC12A5, DLG4, SLC9A6). This study revealed for the first time that Smith-Magenis syndrome, SCN8A-related DEE type 13 and SLC12A5 gene variation are involved in the genetic etiology of (D)EE-SWAS. (D)EE-SWAS is a genetically diverse disorder with underlying copy number variations and single-gene abnormalities. In the current investigation, rare novel variations in genes known to be related to (D)EE-SWAS and not previously reported genes to be related to (D)EE-SWAS were discovered, adding to the molecular genetic spectrum. Molecular etiology enables the patient and family to receive thorough and accurate genetic counseling as well as a personalized medicine approach.
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Affiliation(s)
- Ayberk Türkyılmaz
- Department of Medical Genetics, Karadeniz Technical University Faculty of Medicine, Ortahisar, 61100, Trabzon, Türkiye.
| | - Safiye Güneş Sağer
- Department of Pediatric Neurology, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Türkiye
| | - Emine Tekin
- Department of Pediatric Neurology, Giresun University Maternity and Children Hospital, Giresun, Türkiye
| | - Kerem Teralı
- Department of Medical Biochemistry, Cyprus International University Faculty of Medicine, Nicosia, Cyprus
| | - Hanife Düzkalır
- Department of Radiology, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Türkiye
| | - Metin Eser
- Department of Medical Genetics, Ümraniye Research and Training Hospital, Istanbul, Türkiye
| | - Yasemin Akın
- Department of Pediatrics, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Türkiye
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Rubboli G, Gardella E, Cantalupo G, Alberto Tassinari C. Encephalopathy related to status epilepticus during slow sleep (ESES). Pathophysiological insights and nosological considerations. Epilepsy Behav 2023; 140:109105. [PMID: 36758358 DOI: 10.1016/j.yebeh.2023.109105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
Encephalopathy related to Status Epilepticus during slow Sleep (ESES) is a childhood epilepsy syndrome characterized by the appearance of cognitive, behavioral, and motor disturbances in conjunction with a striking activation of EEG epileptic abnormalities during non-REM sleep. After more than 50 years since the first description, the pathophysiological mechanisms underlying the appearance of encephalopathy in association with a sleep-related enhancement of epileptic discharges are incompletely elucidated. Recent experimental data support the hypothesis that the development of the ESES encephalopathic picture depends on a spike-induced impairment of the synaptic homeostasis processes occurring during normal sleep and that is particularly pronounced during the developmental age. During sleep, synaptic homeostasis is promoted by synaptic weakening/elimination after the increment of synaptic strength that occurs during wakefulness. The EEG can display modifications in synaptic strength by changes in sleep slow wave activity (SWA). Recent studies during active ESES have failed to show changes in sleep SWA, while these changes occurred again after recovery from ESES, thus supporting a spike-related interference on the normal homeostatic processes of sleep. This impairment, during the developmental period, can lead to disruption of cortical wiring and brain plastic remodeling, which lead to the, often irreversible, neuropsychological compromise typical of ESES. From the nosographic point of view, these pathophysiological data lend support to the maintenance of the term ESES, i.e., "encephalopathy related to status epilepticus during sleep". Indeed, this term conveys the concept that the extreme activation of epileptic discharges during sleep is directly responsible for the encephalopathy, hence the importance of defining this condition as an encephalopathy related to the exaggerated activation of epileptic activity during sleep. In this respect, ESES represents a genuine example of a "pure" epileptic encephalopathy in which sleep-related epileptic activity "per se" has a crucial role in determining the encephalopathic picture. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Guido Rubboli
- Danish Epilepsy Center, member of ERN EpiCARE, Kolonivej 1, 4293 Dianalund, Denmark; Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Elena Gardella
- Danish Epilepsy Center, member of ERN EpiCARE, Kolonivej 1, 4293 Dianalund, Denmark; University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Via S. Francesco, 22, 37129 Verona, Italy; Centro Ricerca per le Epilessie in età Pediatrica (CREP), Azienda Ospedaliera Universitaria di Verona, Verona, Italy.
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Amzica F. Impaired sleep homeostasis in children with epilepsy. Dev Med Child Neurol 2023; 65:598-599. [PMID: 36847062 DOI: 10.1111/dmcn.15547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/26/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Florin Amzica
- Stomatology, University of Montreal, Montreal, Quebec, Canada
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