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Rahimi N, Amirifard H, Jameie M. An unusual presentation of severe obstructive sleep apnea with nocturnal seizure-like movements: A case report. Clin Case Rep 2024; 12:e9004. [PMID: 38836112 PMCID: PMC11147746 DOI: 10.1002/ccr3.9004] [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: 11/13/2023] [Revised: 02/10/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024] Open
Abstract
Key Clinical Message This study suggests that severe obstructive sleep apnea can present as sleep-related epileptic or non-epileptic seizures. A detailed history and physical examination, along with polysomnography and video electroencephalography findings can lead to the correct diagnosis. Abstract Obstructive sleep apnea (OSA) is defined by recurrent episodes of the upper airway complete or partial collapse while sleeping. The obstructive episodes result in gradual suffocation that increases breathing attempts till the person is awakened. The main manifestations are excessive daytime sleepiness, snoring, observed episodes of stopped breathing, and abrupt awakenings accompanied by gasping or choking. Nevertheless, there are very few reports of patients with OSA, manifesting other symptoms such as seizure-like movements. Differentiating OSA with nocturnal seizures could be challenging due to their overlapping features. A 53-year-old man presented to the clinic, experiencing seizure-like involuntary movements during nocturnal sleep for the past 2 years with a frequency of 2-3 times per night. Neurologic examinations were normal. Further evaluation with polysomnography revealed impaired arousal followed by seizure-like movements during sleep. Video electroencephalography (EEG) did not show any epileptiform discharges, ruling out the nocturnal seizure diagnosis. The patient was diagnosed with OSA. Subsequently, continuous positive airway pressure (CPAP) treatment resolved all symptoms.
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Affiliation(s)
- Negin Rahimi
- Tehran University of Medical Sciences Tehran Iran
| | - Hamed Amirifard
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
| | - Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
- Neuroscience Research Center Iran University of Medical Sciences Tehran Iran
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2
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Jiang YL, Xia L, Zhao JJ, Zhou HM, Mi D, Wang X, Wang YY, Song CG, Jiang W. Mice harboring the T316N variant in the GABA AR γ 2 subunit exhibit sleep-related hypermotor epilepsy phenotypes and hypersynchronization in the thalamocortical pathway. Exp Neurol 2024; 376:114775. [PMID: 38604438 DOI: 10.1016/j.expneurol.2024.114775] [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: 09/09/2023] [Revised: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Sleep-related hypermotor epilepsy (SHE) is a focal epilepsy syndrome characterized by seizures that predominantly occur during sleep. The pathogenesis of these seizures remains unclear. We previously detected rare variants in GABRG2, which encodes the γ2 subunit of γ-aminobutyric acid type A receptor (GABAAR), in patients with SHE and demonstrated that these variants impaired GABAAR function in vitro. However, the mechanisms by which GABRG2 variants contribute to seizure attacks during sleep remain unclear. METHODS In this study, we designed a knock-in (KI) mouse expressing the mouse Gabrg2 T316N variant, corresponding to human GABRG2 T317N variant, using CRISPR/Cas9. Continuous video-electroencephalogram monitoring and in vivo multichannel electrophysiological recordings were performed to explore seizure susceptibility to pentylenetetrazol (PTZ), alterations in the sleep-wake cycle, spontaneous seizure patterns, and synchronized activity in the motor thalamic nuclei (MoTN) and secondary motor cortex (M2). Circadian variations in the expression of total, membrane-bound, and synaptic GABAAR subunits were also investigated. RESULTS No obvious changes in gross morphology were detected in Gabrg2T316N/+ mice compared to their wild-type (Gabrg2+/+) littermates. Gabrg2T316N/+ mice share key phenotypes with patients, including sleep fragmentation and spontaneous seizures during sleep. Gabrg2T316N/+ mice showed increased susceptibility to PTZ-induced seizures and higher mortality after seizures. Synchronization of the local field potentials between the MoTN and M2 was abnormally enhanced in Gabrg2T316N/+ mice during light phase, when sleep dominates, accompanied by increased local activities in the MoTN and M2. Interestingly, in Gabrg2+/+ mice, GABAAR γ2 subunits showed a circadian increase on the neuronal membrane and synaptosomes in the transition from dark phase to light phase, which was absent in Gabrg2T316N/+ mice. CONCLUSION We generated a new SHE mouse model and provided in vivo evidence that rare variants of GABRG2 contribute to seizure attacks during sleep in SHE.
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Affiliation(s)
- Yong-Li Jiang
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Liang Xia
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Jing-Jing Zhao
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Hui-Min Zhou
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Dan Mi
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Xuan Wang
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Yuan-Yuan Wang
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Chang-Geng Song
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Wen Jiang
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
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3
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Cristóvão Ferreira A, Moniz Dionísio J, Ferreira R, Coelho J. Epileptic seizure or parasomnia? From knowledge to recognition. Sleep-related hypermotor epilepsy. An Pediatr (Barc) 2024; 100:386-387. [PMID: 38614863 DOI: 10.1016/j.anpede.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/26/2023] [Indexed: 04/15/2024] Open
Affiliation(s)
- Ana Cristóvão Ferreira
- Servicio de Pediatría, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | - Joana Moniz Dionísio
- Servicio de Neurología, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Rosário Ferreira
- Unidad de Pulmonología Pediátrica, Servicio de Pediatría, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Facultad de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Coelho
- Unidad de Neuropediatría, Servicio de Pediatría, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Ferri L, Menghi V, Licchetta L, Dimartino P, Minardi R, Davì C, Di Vito L, Cifaldi E, Zenesini C, Gozzo F, Pelliccia V, Mariani V, de Spelorzi YCC, Gustincich S, Seri M, Tassi L, Pippucci T, Bisulli F. Detection of somatic and germline pathogenic variants in adult cohort of drug-resistant focal epilepsies. Epilepsy Behav 2024; 153:109716. [PMID: 38508103 DOI: 10.1016/j.yebeh.2024.109716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study investigates the prevalence of pathogenic variants in the mechanistic target of rapamycin (mTOR) pathway in surgical specimens of malformations of cortical development (MCDs) and cases with negative histology. The study also aims to evaluate the predictive value of genotype-histotype findings on the surgical outcome. METHODS The study included patients with drug-resistant focal epilepsy who underwent epilepsy surgery. Cases were selected based on histopathological diagnosis, focusing on MCDs and negative findings. We included brain tissues both as formalin-fixed, paraffin-embedded (FFPE) or fresh frozen (FF) samples. Single-molecule molecular inversion probes (smMIPs) analysis was conducted, targeting the MTOR gene in FFPE samples and 10 genes within the mTOR pathway in FF samples. Correlations between genotype-histotype and surgical outcome were examined. RESULTS We included 78 patients for whom we obtained 28 FFPE samples and 50 FF tissues. Seventeen pathogenic variants (22 %) were identified and validated, with 13 being somatic within the MTOR gene and 4 germlines (2 DEPDC5, 1 TSC1, 1 TSC2). Pathogenic variants in mTOR pathway genes were exclusively found in FCDII and TSC cases, with a significant association between FCD type IIb and MTOR genotype (P = 0.003). Patients carrying mutations had a slightly better surgical outcome than the overall cohort, however it results not significant. The FCDII diagnosed cases more frequently had normal neuropsychological test, a higher incidence of auras, fewer multiple seizure types, lower occurrence of seizures with awareness impairment, less ictal automatisms, fewer Stereo-EEG investigations, and a longer period long-life of seizure freedom before surgery. SIGNIFICANCE This study confirms that somatic MTOR variants represent the primary genetic alteration detected in brain specimens from FCDII/TSC cases, while germline DEPDC5, TSC1/TSC2 variants are relatively rare. Systematic screening for these mutations in surgically treated patients' brain specimens can aid histopathological diagnoses and serve as a biomarker for positive surgical outcomes. Certain clinical features associated with pathogenic variants in mTOR pathway genes may suggest a genetic etiology in FCDII patients.
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Affiliation(s)
- L Ferri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Via Altura 3, Bologna 40139, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Via Massarenti, 9 - Pad. 11 - 40138 Bologna, Italy
| | - V Menghi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Via Massarenti, 9 - Pad. 11 - 40138 Bologna, Italy; Neurology Unit, Rimini "Infermi" Hospital-AUSL Romagna, Rimini, Italy
| | - L Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Via Altura 3, Bologna 40139, Italy
| | - P Dimartino
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti, 9 - Pad. 11 - 40138 Bologna, Italy
| | - R Minardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Via Altura 3, Bologna 40139, Italy
| | - C Davì
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Via Altura 3, Bologna 40139, Italy
| | - L Di Vito
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Via Altura 3, Bologna 40139, Italy
| | - E Cifaldi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - C Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Via Altura 3, Bologna 40139, Italy
| | - F Gozzo
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milano, Italy
| | - V Pelliccia
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milano, Italy
| | - V Mariani
- Neurology and Stroke Unit, ASST Santi Paolo e Carlo, Presidio San Carlo Borromeo, Milano, Italy
| | - Y C C de Spelorzi
- Genomics Facility, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - S Gustincich
- Center for Human Technologies, Non-coding RNAs and RNA-based Therapeutics, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - M Seri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Via Massarenti, 9 - Pad. 11 - 40138 Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - L Tassi
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milano, Italy
| | - T Pippucci
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Via Massarenti, 9 - Pad. 11 - 40138 Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - F Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Via Altura 3, Bologna 40139, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Via Massarenti, 9 - Pad. 11 - 40138 Bologna, Italy.
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Avidan AY. The Clinical Spectrum of the Parasomnias. Sleep Med Clin 2024; 19:1-19. [PMID: 38368057 DOI: 10.1016/j.jsmc.2023.12.003] [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] [Indexed: 02/19/2024]
Abstract
Parasomnias are defined as abnormal movements or behaviors that occur in sleep or during arousals from sleep. Parasomnias vary in frequency from episodic events that arise from incomplete sleep state transition. The framework by which parasomnias are categorized and diagnosed is based on the International Classification of Sleep Disorders-Third Edition, Text Revision (ICSD-3-TR), published by the American Academy of Sleep Medicine. The recent Third Edition, Text Revision (ICSD-3-TR) of the ICSD provides an expert consensus of the diagnostic requirements for sleep disorders, including parasomnias, based on an extensive review of the current literature.
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Affiliation(s)
- Alon Y Avidan
- Department of Neurology, UCLA Sleep Disorders Center, UCLA, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, RNRC, C153, Mail Code 176919, Los Angeles, CA 90095-1769, USA.
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Irfan M. Sleep Terrors. Sleep Med Clin 2024; 19:63-70. [PMID: 38368070 DOI: 10.1016/j.jsmc.2023.12.004] [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] [Indexed: 02/19/2024]
Abstract
Sleep terrors, categorized under disorders of arousal, more prevalent in pediatric population, generally are self-limited but sometimes can persist or occur in adulthood. These are primed by factors enhancing homeostatic drive on backdrop of developmental predisposition and are precipitated by factors increasing sleep fragmentation resulting in dissociated state of sleep with some cerebral regions showing abnormal slow wave activity and others fast activity. This phenotypically evolves into abrupt partial arousal with individual arousing from N3 or N2 sleep with behaviors representing intense fear such as crying with autonomic hyperactivity. There is no recollection of the event, and lack of vivid dream mentation although fragmented imagery may be noted. Behavioral management is of prime importance including addressing precipitating factors, family reassurance, safety measures, and scheduled awakenings. Pharmacologic agents such as clonazepam and antidepressants are used infrequently in case of disruptive episodes.
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Affiliation(s)
- Muna Irfan
- Department of Neurology, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, 1816 Ellie Court, Eagan, MN 55122, USA.
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7
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Bruni O, DelRosso LM, Melegari MG, Ferri R. The Parasomnias. Psychiatr Clin North Am 2024; 47:135-146. [PMID: 38302202 DOI: 10.1016/j.psc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy.
| | - Lourdes M DelRosso
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA
| | - Maria Grazia Melegari
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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8
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Mainieri G, Provini F. Commentary on "Parasomnias manifest different phenotypes of sleep-related behaviors in age and sex groups. A YouTube-based video research highlighting the age slope of sleepwalking". J Clin Neurosci 2024:S0967-5868(24)00077-8. [PMID: 38378318 DOI: 10.1016/j.jocn.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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9
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Fukuyama K, Motomura E, Okada M. Age-Dependent Activation of Purinergic Transmission Contributes to the Development of Epileptogenesis in ADSHE Model Rats. Biomolecules 2024; 14:204. [PMID: 38397441 PMCID: PMC10886636 DOI: 10.3390/biom14020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
To explore the developmental processes of epileptogenesis/ictogenesis, this study determined age-dependent functional abnormalities associated with purinergic transmission in a genetic rat model (S286L-TG) of autosomal-dominant sleep-related hypermotor epilepsy (ADSHE). The age-dependent fluctuations in the release of ATP and L-glutamate in the orbitofrontal cortex (OFC) were determined using microdialysis and ultra-high-performance liquid chromatography with mass spectrometry (UHPLC-MS). ATP release from cultured astrocytes was also determined using UHPLC-MS. The expressions of P2X7 receptor (P2X7R), connexin 43, phosphorylated-Akt and phosphorylated-Erk were determined using capillary immunoblotting. No functional abnormalities associated with purinergic transmission could be detected in the OFC of 4-week-old S286L-TG and cultured S286L-TG astrocytes. However, P2X7R expression, as well as basal and P2X7R agonist-induced ATP releases, was enhanced in S286L-TG OFC in the critical ADSHE seizure onset period (7-week-old). Long-term exposure to a modest level of P2X7R agonist, which could not increase astroglial ATP release, for 14 d increased the expressions of P2X7R and connexin 43 and the signaling of Akt and Erk in astrocytes, and it enhanced the sensitivity of P2X7R to its agonists. Akt but not Erk increased P2X7R expression, whereas both Akt and Erk increased connexin 43 expression. Functional abnormalities, enhanced ATP release and P2X7R expression were already seen before the onset of ADSHE seizure in S286L-TG. Additionally, long-term exposure to the P2X7R agonist mimicked the functional abnormalities associated with purinergic transmission in astrocytes, similar to those in S286L-TG OFC. Therefore, these results suggest that long-term modestly enhanced purinergic transmission and/or activated P2X7R are, at least partially, involved in the development of the epileptogenesis of ADSHE, rather than that of ictogenesis.
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Affiliation(s)
| | | | - Motohiro Okada
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (K.F.); (E.M.)
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Lopez R, Dauvilliers Y. Challenges in diagnosing NREM parasomnias: Implications for future diagnostic classifications. Sleep Med Rev 2024; 73:101888. [PMID: 38150767 DOI: 10.1016/j.smrv.2023.101888] [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: 08/28/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
NREM parasomnias are frequent and potentially disabling sleep disorders characterized by recurrent abnormal behaviors emerging from NREM sleep. Recently, several studies provided more detailed clinical and polysomnographic characterization of NREM parasomnia which may enhance the diagnostic process. Several revisions of the diagnostic criteria have been proposed in the classification of sleep disorders, the latest being ICSD-3-TR in 2023 with no changes on NREM parasomnias since ICSD-3 published in 2014. We performed an extensive literature review to assess the evidence on the procedure of its diagnosis. We dissected the inconsistencies and shortcomings in the ICSD-3-TR to propose a revision of the current diagnostic criteria. We highlighted the limits of several clinical criteria which should rather be supportive features than mandatory criteria. Infrared cameras with video-recordings with are promising tools to precisely characterize home episodes. Sensitive and specific polysomnographic markers of NREM parasomnias have been identified and should be considered in future revisions. We also suggest the use of diagnostic specifiers (clinical subtypes, clinical significance, levels of severity, age effect, levels of certainty) to define homogeneous subgroups of patients for therapeutic intervention and research purposes. In conclusion, we advocate for significant changes in the current diagnostic criteria of NREM parasomnias for future classification.
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Affiliation(s)
- Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
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Acharya JN. REM parasomnias: Straddling the sleep-wake line. Clin Neurophysiol Pract 2024; 9:51-52. [PMID: 38328387 PMCID: PMC10847008 DOI: 10.1016/j.cnp.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Jayant N. Acharya
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
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12
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Boisclair M, Hadjinicolaou A, Nigam M. Clinical Reasoning: A 3-Year-Old Boy With Abnormal Movements During Sleep. Neurology 2023; 101:1134-1139. [PMID: 37857493 PMCID: PMC10791058 DOI: 10.1212/wnl.0000000000207980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
We report a case of a 3-year-old boy who presented with abnormal movements that initially occurred only during sleep. Three years later, he went on to develop hyperkinetic movements during the daytime while awake. There was a strong family history of various paroxysmal neurologic disorders. In this report, we discuss the clinical approach, differential diagnosis, investigation, and treatment options for nocturnal hyperkinetic movements and paroxysmal movement disorders.
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Affiliation(s)
- Mélissa Boisclair
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Aristides Hadjinicolaou
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Milan Nigam
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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De Stefano P, Ménétré E, Stancu P, Mégevand P, Vargas MI, Kleinschmidt A, Vulliémoz S, Wiest R, Beniczky S, Picard F, Seeck M. Added value of advanced workup after the first seizure: A 7-year cohort study. Epilepsia 2023; 64:3246-3256. [PMID: 37699424 DOI: 10.1111/epi.17771] [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: 04/19/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE This study was undertaken to establish whether advanced workup including long-term electroencephalography (LT-EEG) and brain magnetic resonance imaging (MRI) provides an additional yield for the diagnosis of new onset epilepsy (NOE) in patients presenting with a first seizure event (FSE). METHODS In this population-based study, all adult (≥16 years) patients presenting with FSE in the emergency department (ED) between March 1, 2010 and March 1, 2017 were assessed. Patients with obvious nonepileptic or acute symptomatic seizures were excluded. Routine EEG, LT-EEG, brain computed tomography (CT), and brain MRI were performed as part of the initial workup. These examinations' sensitivity and specificity were calculated on the basis of the final diagnosis after 2 years, along with the added value of advanced workup (MRI and LT-EEG) over routine workup (routine EEG and CT). RESULTS Of the 1010 patients presenting with FSE in the ED, a definite diagnosis of NOE was obtained for 501 patients (49.6%). Sensitivity of LT-EEG was higher than that of routine EEG (54.39% vs. 25.5%, p < .001). Similarly, sensitivity of MRI was higher than that of CT (67.98% vs. 54.72%, p = .009). Brain MRI showed epileptogenic lesions in an additional 32% compared to brain CT. If only MRI and LT-EEG were considered, five would have been incorrectly diagnosed as nonepileptic (5/100, 5%) compared to patients with routine EEG and MRI (25/100, 25%, p = .0001). In patients with all four examinations, advanced workup provided an overall additional yield of 50% compared to routine workup. SIGNIFICANCE Our results demonstrate the remarkable added value of the advanced workup launched already in the ED for the diagnosis of NOE versus nonepileptic causes of seizure mimickers. Our findings suggest the benefit of first-seizure tracks or even units with overnight EEG, similar to stroke units, activated upon admission in the ED.
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Affiliation(s)
- Pia De Stefano
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Eric Ménétré
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrick Stancu
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Andreas Kleinschmidt
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Vulliémoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Berne, Bern, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus and Danish Epilepsy Center, Dianalund, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Fabienne Picard
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
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14
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Dainelli A, Iacomino M, Rossato S, Bugin S, Traverso M, Severino M, Gustincich S, Capra V, Di Duca M, Zara F, Scala M, Striano P. Refining the electroclinical spectrum of NPRL3-related epilepsy: A novel multiplex family and literature review. Epilepsia Open 2023; 8:1314-1330. [PMID: 37491868 PMCID: PMC10690669 DOI: 10.1002/epi4.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE NPRL3-related epilepsy (NRE) is an emerging condition set within the wide GATOR-1 spectrum with a particularly heterogeneous and elusive phenotypic expression. Here, we delineated the genotype-phenotype spectrum of NRE, reporting an illustrative familial case and reviewing pertinent literature. METHODS Through exome sequencing (ES), we investigated a 12-year-old girl with recurrent focal motor seizures during sleep, suggestive of sleep-related hypermotor epilepsy (SHE), and a family history of epilepsy in siblings. Variant segregation analysis was performed by Sanger sequencing. All previously published NRE patients were thoroughly reviewed and their electroclinical features were analyzed and compared with the reported subjects. RESULTS In the proband, ES detected the novel NPRL3 frameshift variant (NM_001077350.3): c.151_152del (p.Thr51Glyfs*5). This variant is predicted to cause a loss of function and segregated in one affected brother. The review of 76 patients from 18 publications revealed the predominance of focal-onset seizures (67/74-90%), with mainly frontal and frontotemporal (32/67-47.7%), unspecified (19/67-28%), or temporal (9/67-13%) onset. Epileptic syndromes included familial focal epilepsy with variable foci (FFEVF) (29/74-39%) and SHE (11/74-14.9%). Fifteen patients out of 60 (25%) underwent epilepsy surgery, 11 of whom achieved complete seizure remission (11/15-73%). Focal cortical dysplasia (FCD) type 2A was the most frequent histopathological finding. SIGNIFICANCE We reported an illustrative NPRL3-related epilepsy (NRE) family with incomplete penetrance. This condition consists of a heterogeneous spectrum of clinical and neuroradiological features. Focal-onset motor seizures are predominant, and almost half of the cases fulfill the criteria for SHE or FFEVF. MRI-negative cases are prevalent, but the association with malformations of cortical developments (MCDs) is significant, especially FCD type 2a. The beneficial impact of epilepsy surgery in patients with MCD-related epilepsy further supports the inclusion of brain MRI in the workup of NRE patients.
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Affiliation(s)
- Alice Dainelli
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto Giannina GasliniGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversità Degli Studi di GenovaGenoaItaly
| | | | - Sara Rossato
- U.O.C. Pediatria, Ospedale San BortoloVicenzaItaly
| | | | - Monica Traverso
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto Giannina GasliniGenoaItaly
| | | | | | - Valeria Capra
- UOC Genetica MedicaIRCCS Istituto Giannina GasliniGenoaItaly
| | - Marco Di Duca
- UOC Genetica MedicaIRCCS Istituto Giannina GasliniGenoaItaly
| | - Federico Zara
- UOC Genetica MedicaIRCCS Istituto Giannina GasliniGenoaItaly
| | - Marcello Scala
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto Giannina GasliniGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversità Degli Studi di GenovaGenoaItaly
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto Giannina GasliniGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversità Degli Studi di GenovaGenoaItaly
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15
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El Youssef N, Marchi A, Bartolomei F, Bonini F, Lambert I. Sleep and epilepsy: A clinical and pathophysiological overview. Rev Neurol (Paris) 2023; 179:687-702. [PMID: 37598088 DOI: 10.1016/j.neurol.2023.07.006] [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: 07/14/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
The interaction between sleep and epilepsy is complex. A better understanding of the mechanisms linking sleep and epilepsy appears increasingly important as it may improve diagnosis and therapeutic strategies in patients with epilepsy. In this narrative review, we aim to (i) provide an overview of the physiological and pathophysiological processes linking sleep and epilepsy; (ii) present common sleep disorders in patients with epilepsy; (iii) discuss how sleep and sleep disorders should be considered in new therapeutic approaches to epilepsy such as neurostimulation; and (iv) present the overall nocturnal manifestations and differential diagnosis between epileptic seizures and parasomnia.
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Affiliation(s)
- N El Youssef
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France
| | - A Marchi
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France
| | - F Bartolomei
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France
| | - F Bonini
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France
| | - I Lambert
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France.
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16
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Lopez R, Micoulaud-Franchi JA, Peter-Derex L, Dauvilliers Y. Nocturnal agitation: From sleep state dissociation to sleep-related dissociative state. Rev Neurol (Paris) 2023; 179:675-686. [PMID: 37625976 DOI: 10.1016/j.neurol.2023.07.003] [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: 07/20/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate identification of its etiology is critical for appropriate therapeutic intervention. In children and young adults, distinguishing between non-rapid eye movement (NREM) sleep parasomnias and psychogenic non-parasomniac manifestations, a condition known as sleep-related dissociative disorder (SRDD), can be challenging. This review aims to summarize current clinical, neurophysiological, and epidemiological knowledge on NREM parasomnia and SRDD, and to present the pathophysiological hypotheses underlying these nocturnal manifestations. Sleepwalking, sleep terror and confusional arousals are the three main presentations of NREM parasomnias and share common clinical characteristics. Parasomniac episodes generally occur 30minutes to three hours after sleep-onset, they are usually short, lasting no more than few minutes and involve non-stereotyped, clumsy behaviors with frequent amnesia. The prevalence of NREM parasomnia decreases from 15-30% in children to 2-4% in adults. Parasomniac episodes are incomplete awakening from the deepest NREM sleep and are characterized by a dissociated brain activity, with a wake-like activation in motor and limbic structures and a preserved sleep in the fronto-parietal regions. SRDD is a less known condition characterized by dramatic, often very long episodes with frequent aggressive and potentially dangerous behaviors. SRDD episodes frequently occur in quiet wakefulness before falling asleep. These dissociative manifestations are frequently observed in the context of psychological trauma. The pathophysiology of SRDD is poorly understood but could involve transient changes in brain connectivity due to labile sleep-wake boundaries in predisposed individuals. We hypothesize that SRDD and NREM parasomnia are forms of sleep-related dissociative states favored by a sleep-wake state dissociation during sleep-onset and awakening process, respectively.
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Affiliation(s)
- R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - L Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center, PAM Team, Inserm U1028, CNRS UMR 5292, Lyon, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
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17
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Vallés AS, Barrantes FJ. Nicotinic Acetylcholine Receptor Dysfunction in Addiction and in Some Neurodegenerative and Neuropsychiatric Diseases. Cells 2023; 12:2051. [PMID: 37626860 PMCID: PMC10453526 DOI: 10.3390/cells12162051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
The cholinergic system plays an essential role in brain development, physiology, and pathophysiology. Herein, we review how specific alterations in this system, through genetic mutations or abnormal receptor function, can lead to aberrant neural circuitry that triggers disease. The review focuses on the nicotinic acetylcholine receptor (nAChR) and its role in addiction and in neurodegenerative and neuropsychiatric diseases and epilepsy. Cholinergic dysfunction is associated with inflammatory processes mainly through the involvement of α7 nAChRs expressed in brain and in peripheral immune cells. Evidence suggests that these neuroinflammatory processes trigger and aggravate pathological states. We discuss the preclinical evidence demonstrating the therapeutic potential of nAChR ligands in Alzheimer disease, Parkinson disease, schizophrenia spectrum disorders, and in autosomal dominant sleep-related hypermotor epilepsy. PubMed and Google Scholar bibliographic databases were searched with the keywords indicated below.
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Affiliation(s)
- Ana Sofía Vallés
- Bahía Blanca Institute of Biochemical Research (UNS-CONICET), Bahía Blanca 8000, Argentina;
| | - Francisco J. Barrantes
- Biomedical Research Institute (BIOMED), Faculty of Medical Sciences, Pontifical Catholic University of Argentina—National Scientific and Technical Research Council, Av. Alicia Moreau de Justo 1600, Buenos Aires C1107AFF, Argentina
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18
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Perversi F, Costa C, Labate A, Lattanzi S, Liguori C, Maschio M, Meletti S, Nobili L, Operto FF, Romigi A, Russo E, Di Bonaventura C. The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy. Front Neurol 2023; 14:1182304. [PMID: 37483446 PMCID: PMC10359664 DOI: 10.3389/fneur.2023.1182304] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Glutamate is the brain's main excitatory neurotransmitter. Glutamatergic neurons primarily compose basic neuronal networks, especially in the cortex. An imbalance of excitatory and inhibitory activities may result in epilepsy or other neurological and psychiatric conditions. Among glutamate receptors, AMPA receptors are the predominant mediator of glutamate-induced excitatory neurotransmission and dictate synaptic efficiency and plasticity by their numbers and/or properties. Therefore, they appear to be a major drug target for modulating several brain functions. Perampanel (PER) is a highly selective, noncompetitive AMPA antagonist approved in several countries worldwide for treating different types of seizures in various epileptic conditions. However, recent data show that PER can potentially address many other conditions within epilepsy and beyond. From this perspective, this review aims to examine the new preclinical and clinical studies-especially those produced from 2017 onwards-on AMPA antagonism and PER in conditions such as mesial temporal lobe epilepsy, idiopathic and genetic generalized epilepsy, brain tumor-related epilepsy, status epilepticus, rare epileptic syndromes, stroke, sleep, epilepsy-related migraine, cognitive impairment, autism, dementia, and other neurodegenerative diseases, as well as provide suggestions on future research agenda aimed at probing the possibility of treating these conditions with PER and/or other AMPA receptor antagonists.
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Affiliation(s)
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Neurological Clinic, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome ‘Tor Vergata”, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital “Tor Vergata”, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Meletti
- Neurology Department, University Hospital of Modena, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Romigi
- Sleep Medicine Center, Neurological Mediterranean Institute IRCCS Neuromed, Pozzilli, Italy
- Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | - Emilio Russo
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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19
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Lam N, Veeravigrom M. Sleep-related rhythmic movement disorder in children: a mini-review. Front Neurol 2023; 14:1165130. [PMID: 37255722 PMCID: PMC10225739 DOI: 10.3389/fneur.2023.1165130] [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: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Sleep-related rhythmic movement disorder (SRRMD) occurs in both infants and children. This disorder rarely occurs or persists in adolescence or adulthood. Rhythmic movement during sleep in children is often asymptomatic and considered a benign condition. It is classified as SRRMD when movement significantly disrupts sleep, results in daytime functional impairment, or causes self-inflicted body injury. Several studies have demonstrated that SRRMD occurs in all sleep stages. Few studies have investigated rhythmic movement disorder (RMD) in children. SRRMD is a clinical diagnosis supported by home video recordings. When the clinical history is insufficient to provide a definitive diagnosis of SRRMD, and other sleep-related conditions or seizure disorders are suspected, video-polysomnography is indicated. There are currently no clinical guidelines for treating SRRMD.
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Affiliation(s)
- Nhi Lam
- Sleep Medicine Program, Department of Pulmonary Medicine, University of Chicago, Chicago, IL, United States
| | - Montida Veeravigrom
- Section of Child Neurology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, United States
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20
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Hoque R. Evaluating paroxysmal nocturnal retching/gagging in the sleep medicine clinic. Sleep Med 2023; 107:46-47. [PMID: 37105070 DOI: 10.1016/j.sleep.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Romy Hoque
- Emory Sleep Center, Emory Epilepsy Program, Atlanta, GA, USA.
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21
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Mirandola L, Cantalupo G, d'Orsi G, Meletti S, Vaudano AE, Di Vito L, Vignoli A, Tassi L, Pelliccia V. Ictal semiology of gelastic seizures. Epilepsy Behav 2023; 140:109025. [PMID: 36780776 DOI: 10.1016/j.yebeh.2022.109025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 02/13/2023]
Abstract
Gelastic seizures are rare epileptic manifestations characterized by laughter or a smile. The main etiology is represented by hypothalamic hamartoma, but also focal localization of the epileptogenic zone is described. We reviewed a group of patients with gelastic seizures to describe the semiology and to establish any difference related to diverse epilepsy etiologies. Thirty-five seizures from 16 patients (6 females) were reviewed. The study confirms that hypothalamic hamartoma is the more frequent etiology associated with gelastic seizures. Laughter represented the majority of gelastic ictal signs, while the ictal smile was less frequent. In 87.5% of patients, the manifestation of laughter or smile was the only ictal phenomenon, or the first and the most important clinical sign. Interestingly, it has been observed that patients with a lesion localized in the hypothalamic region had more frequently laughter with emotional involvement and that laughter was the only manifestation of the seizure. On the contrary, patients with lesions localized outside the hypothalamic region had more often seizures with laugh without emotional involvement, resembling a more mechanical action, and associated with other semeiological signs. It, therefore, seems possible to assume that the emotional involvement and the expression of mirth during the seizure, especially in children, are more frequently associated with hypothalamic hamartoma. On the contrary, when the semiology includes less conveyed emotion similar to a mechanical action and other symptoms, an extra hypothalamic localization should be considered.
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Affiliation(s)
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Research Center for Pediatric Epilepsies Verona, Italy
| | - Giuseppe d'Orsi
- Neurology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Fg), Italy; Epilepsy Center - Clinic of Nervous System Disease, Policlinico Riuniti, Foggia, Italy
| | - Stefano Meletti
- Division of Neurology, University Hospital of Modena, Modena, Italy; Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Elisabetta Vaudano
- Division of Neurology, University Hospital of Modena, Modena, Italy; Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Lidia Di Vito
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Aglaia Vignoli
- Childhood and Adolescence Neurology and Psychiatry Unit, Niguarda Hospital Department of Health Sciences, University of Milan, Milan, Italy; Epilepsy Center-Child Neuropsychiatric Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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22
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Becchetti A, Grandi LC, Cerina M, Amadeo A. Nicotinic acetylcholine receptors and epilepsy. Pharmacol Res 2023; 189:106698. [PMID: 36796465 DOI: 10.1016/j.phrs.2023.106698] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Despite recent advances in understanding the causes of epilepsy, especially the genetic, comprehending the biological mechanisms that lead to the epileptic phenotype remains difficult. A paradigmatic case is constituted by the epilepsies caused by altered neuronal nicotinic acetylcholine receptors (nAChRs), which exert complex physiological functions in mature as well as developing brain. The ascending cholinergic projections exert potent control of forebrain excitability, and wide evidence implicates nAChR dysregulation as both cause and effect of epileptiform activity. First, tonic-clonic seizures are triggered by administration of high doses of nicotinic agonists, whereas non-convulsive doses have kindling effects. Second, sleep-related epilepsy can be caused by mutations on genes encoding nAChR subunits widely expressed in the forebrain (CHRNA4, CHRNB2, CHRNA2). Third, in animal models of acquired epilepsy, complex time-dependent alterations in cholinergic innervation are observed following repeated seizures. Heteromeric nAChRs are central players in epileptogenesis. Evidence is wide for autosomal dominant sleep-related hypermotor epilepsy (ADSHE). Studies of ADSHE-linked nAChR subunits in expression systems suggest that the epileptogenic process is promoted by overactive receptors. Investigation in animal models of ADSHE indicates that expression of mutant nAChRs can lead to lifelong hyperexcitability by altering i) the function of GABAergic populations in the mature neocortex and thalamus, ii) synaptic architecture during synaptogenesis. Understanding the balance of the epileptogenic effects in adult and developing networks is essential to plan rational therapy at different ages. Combining this knowledge with a deeper understanding of the functional and pharmacological properties of individual mutations will advance precision and personalized medicine in nAChR-dependent epilepsy.
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Affiliation(s)
- Andrea Becchetti
- Department of Biotechnology and Biosciences, and NeuroMI (Milan Center of Neuroscience), University of Milano-Bicocca, Piazza della Scienza 2, Milano 20126, Italy.
| | - Laura Clara Grandi
- Department of Biotechnology and Biosciences, and NeuroMI (Milan Center of Neuroscience), University of Milano-Bicocca, Piazza della Scienza 2, Milano 20126, Italy.
| | - Marta Cerina
- Department of Biotechnology and Biosciences, and NeuroMI (Milan Center of Neuroscience), University of Milano-Bicocca, Piazza della Scienza 2, Milano 20126, Italy.
| | - Alida Amadeo
- Department of Biosciences, University of Milano, Via Celoria 26, Milano 20133, Italy.
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23
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Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype? J Clin Med 2023; 12:jcm12010372. [PMID: 36615171 PMCID: PMC9821298 DOI: 10.3390/jcm12010372] [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: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.
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Puligheddu M, Congiu P, Figorilli M, Tamburrino L, Pisanu P, Coa R, Mascia MG, Fonti D, Lecca R, Grossi E, Gagliano A. Neuropsychological and Behavioral Profile in Sleep-Related Hypermotor Epilepsy (SHE) and Disorders of Arousal (DOA): A Multimodal Analysis. J Clin Med 2023; 12:jcm12010374. [PMID: 36615172 PMCID: PMC9820873 DOI: 10.3390/jcm12010374] [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: 12/04/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
STUDY OBJECTIVES Disorder of arousal (DOA) and sleep-related hypermotor epilepsy (SHE) are complex, often bizarre, involuntary sleep behaviors, whose differential diagnosis may be challenging because they share some clinical features, such as sleep fragmentation. Mounting evidence highlights the critical role of sleep in cognitive functions. Controversial findings are raised about the cognitive profile in SHE; however, no studies have investigated the cognitive profile in DOA. This study aimed to assess whether sleep instability affects cognitive functions in patients with SHE or DOA. METHODS This study analyzed 11 patients with DOA, 11 patients with SHE, and 22 healthy controls (HC). They underwent full-night video polysomnography (vPSG) and comprehensive neuropsychological and behavioral evaluation. Differences in the variables of interest among the SHE group, DOA group, and their respective control groups were evaluated. The auto-contractive map (auto-CM) system was used to evaluate the strength of association across the collected data. RESULTS The SHE group had reduced sleep efficiency and increased wake after sleep onset (WASO); both the SHE and DOA groups showed increased % of N2 and REM sleep compared to the HC group. Neuropsychological and behavioral evaluations showed a different cognitive profile in the SHE group with respect to the HC group. The auto-CM showed that Pittsburgh Sleep Quality Index (PSQI), Beck depression inventory (BDI), MWCST_PE, Epworth sleepiness scale (ESS), WASO, N1, and % REM were strictly correlated with SHE, whereas the SE and arousal index (AI) were strictly related to DOA. CONCLUSIONS Patients with SHE and DOA present different cognitive and psychiatric profiles, with subtle and selective cognitive impairments only in those with SHE, supporting the discriminative power of cognitive and psychiatric assessment in these two conditions.
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Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
- Correspondence: ; Tel.: +39-0706754952
| | - Patrizia Congiu
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Michela Figorilli
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Patrizia Pisanu
- UOC Riabilitazione Funzionale e Neuroriabilitazione, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Roberta Coa
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | | | - Davide Fonti
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Foundation, 22038 Tavernerio, Italy
| | - Antonella Gagliano
- Unità di Neuropsichiatria dell’infanzia e dell’adolescenza, Dipartimento di Scienze Biomediche, Università di Cagliari & Ospedale Pediatrico, 09100 Cagliari, Italy
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25
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Zahra A, Sun Y, Aloysius N, Zhang L. Convulsive behaviors of spontaneous recurrent seizures in a mouse model of extended hippocampal kindling. Front Behav Neurosci 2022; 16:1076718. [PMID: 36620863 PMCID: PMC9816810 DOI: 10.3389/fnbeh.2022.1076718] [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: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Growing studies indicate that vigilance states and circadian rhythms can influence seizure occurrence in patients with epilepsy and rodent models of epilepsy. Electrical kindling, referred to brief, repeated stimulations of a limbic structure, is a commonly used model of temporal lobe epilepsy. Kindling via the classic protocol lasting a few weeks does not generally induce spontaneous recurrent seizures (SRS), but extended kindling that applies over the course of a few months has shown to induce SRS in several animal species. Kindling-induced SRS in monkeys and cats were observed mainly during resting wakefulness or sleep, but the behavioral activities associated with SRS in rodent models of extended kindling remain unknown. We aimed to add information in this area using a mouse model of extended hippocampal kindling. Middle-aged C57 black mice experienced ≥80 hippocampal stimulations (delivered twice daily) and then underwent continuous 24 h electroencephalography (EEG)-video monitoring for SRS detection. SRS were recognized by EEG discharges and associated motor seizures. The five stages of the modified Racine scale for mice were used to score motor seizure severities. Seizure-preceding behaviors were assessed in a 3 min period prior to seizure onset and categorized as active and inactive. Three main observations emerged from the present analysis. (1) SRS were found to predominantly manifest as generalized (stage 3-5) motor seizures in association with tail erection or Straub tail. (2) SRS occurrences were not significantly altered by the light on/off cycle. (3) Generalized (stage 3-5) motor seizures were mainly preceded by inactive behaviors such as immobility, standing still, or apparent sleep without evident volitional movement. Considering deeper subcortical structures implicated in genesis of tail erection in other seizure models, we postulate that genesis of generalized motor seizures in extended kindled mice may involve deeper subcortical structures. Our present data together with previous findings from post-status epilepticus models support the notion that ambient cage behaviors are strong influencing factors of SRS occurrence in rodent models of temporal lobe epilepsy.
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Affiliation(s)
- Anya Zahra
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Yuqing Sun
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Nancy Aloysius
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Liang Zhang
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada,*Correspondence: Liang Zhang,
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26
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Wan X, Zhang P, Wang W, Wu X, Tan Q, Su X, Zhang S, Yang X, Li S, Shao H, Yue Q, Gong Q. Abnormal brain functional network dynamics in sleep-related hypermotor epilepsy. CNS Neurosci Ther 2022; 29:659-668. [PMID: 36510701 PMCID: PMC9873504 DOI: 10.1111/cns.14048] [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: 04/13/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS This study aimed to use resting-state functional magnetic resonance imaging (rs-fMRI) to determine the temporal features of functional connectivity states and changes in connectivity strength in sleep-related hypermotor epilepsy (SHE). METHODS High-resolution T1 and rs-fMRI scanning were performed on all the subjects. We used a sliding-window approach to construct a dynamic functional connectivity (dFC) network. The k-means clustering method was performed to analyze specific FC states and related temporal properties. Finally, the connectivity strength between the components was analyzed using network-based statistics (NBS) analysis. The correlations between the abovementioned measures and disease duration were analyzed. RESULTS After k-means clustering, the SHE patients mainly exhibited two dFC states. The frequency of state 1 was higher, which was characterized by stronger connections within the networks; state 2 occurred at a relatively low frequency, characterized by stronger connections between networks. SHE patients had greater fractional time and a mean dwell time in state 2 and had a larger number of state transitions. The NBS results showed that SHE patients had increased connectivity strength between networks. None of the properties was correlated with illness duration among patients with SHE. CONCLUSION The patterns of dFC patterns may represent an adaptive and protective mode of the brain to deal with epileptic seizures.
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Affiliation(s)
- Xinyue Wan
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina,Department of Radiology, Huashan HospitalFudan UniversityShanghaiChina
| | - Pengfei Zhang
- Second Clinical SchoolLanzhou UniversityLanzhouChina,Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
| | - Weina Wang
- Department of Radiology, The First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Xintong Wu
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
| | - Qiaoyue Tan
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Xiaorui Su
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Simin Zhang
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Xibiao Yang
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Shuang Li
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Hanbing Shao
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Qiang Yue
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina,Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina,Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceChengduChina,Department of RadiologyWest China Xiamen Hospital of Sichuan UniversityXiamenFujianChina
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27
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Mora-Munoz L, Alsheikhtaha Z, Foldvary-Schaefer N. Differential Diagnosis of Complex Nocturnal Behaviors. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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28
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Parrino L, Halasz P, Szucs A, Thomas RJ, Azzi N, Rausa F, Pizzarotti S, Zilioli A, Misirocchi F, Mutti C. Sleep medicine: Practice, challenges and new frontiers. Front Neurol 2022; 13:966659. [PMID: 36313516 PMCID: PMC9616008 DOI: 10.3389/fneur.2022.966659] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.
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Affiliation(s)
- Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- *Correspondence: Liborio Parrino
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szucs
- Department of Behavioral Sciences, National Institute of Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Nicoletta Azzi
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Francesco Rausa
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Silvia Pizzarotti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Alessandro Zilioli
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Francesco Misirocchi
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
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29
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Villa C, Arrigoni F, Rivellini E, Lavitrano M, De Gioia L, Ferini-Strambi L, Combi R. Exome Sequencing in an ADSHE Family: VUS Identification and Limits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12548. [PMID: 36231847 PMCID: PMC9565017 DOI: 10.3390/ijerph191912548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Autosomal dominant sleep-related hypermotor epilepsy (ADSHE) is the familial form of a focal epilepsy characterized by hyperkinetic focal seizures, mainly arising during non-rapid eye movements (NREM) sleep. Mutations associated with ADSHE account for a small proportion of the genetically determined cases, suggesting the existence of other disease-causing genes. Here, we reported the results obtained by performing trio-based whole-exome sequencing (WES) in an Italian family showing ADSHE and investigated the structural impact of putative variants by in silico modeling analysis. We identified a p.(Trp276Gly) variant in MOXD1 gene encoding the monooxigenase DBH like 1 protein, cosegregating with the disease and annotated as VUS under the ACMG recommendations. Structural bioinformatic analysis predicted a high destabilizing effect of this variant, due to the loss of important hydrophilic bonds and an expansion of cavity volume in the protein hydrophobic core. Although our data support a functional effect of the p.(Trp276Gly) variant, we highlight the need to identify additional families carrying MOXD1 mutations or functional analyses in suitable models to clarify its role in ADSHE pathogenesis. Moreover, we discuss the importance of VUS reporting due to the low rate of pathogenic variant identification by NGS in epilepsy and for future reinterpretation studies.
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Affiliation(s)
- Chiara Villa
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Federica Arrigoni
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, 20126 Milan, Italy
| | - Eleonora Rivellini
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marialuisa Lavitrano
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Luca De Gioia
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, 20126 Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology-Sleep Disorder Center, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, 20127 Milan, Italy
| | - Romina Combi
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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30
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Meurling IJ, Leschziner G, Drakatos P. What respiratory physicians should know about parasomnias. Breathe (Sheff) 2022; 18:220067. [PMID: 36340819 PMCID: PMC9584583 DOI: 10.1183/20734735.0067-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/26/2022] [Indexed: 11/13/2022] Open
Abstract
Parasomnias have significant quality-of-life, prognostic and potentially forensic implications for patients and their bed-partners. Identifying key clinical features will accelerate diagnosis and appropriate management for these patients. Parasomnias are undesirable physical events or experiences that arise out of, or during, sleep. They can include movements, behaviours, emotions, perceptions, dreams or autonomic nervous system activity. While more common during childhood, they can persist into, or present de novo, during adulthood. Parasomnias can arise out of non-rapid eye movement (NREM) sleep, as in confusional arousals, sleepwalking, sleep terrors or sleep-related eating disorder, or out of REM sleep, as in REM behaviour disorder, recurrent isolated sleep paralysis or nightmare disorder. Sleep-related hypermotor epilepsy is an important differential diagnosis to consider in patients presenting with a parasomnia. A thorough clinical history, including a collateral history if available, is crucial to identify characteristic clinical features. Video polysomnography is useful to identify macro- and micro-sleep architectural features, characteristic behavioural events, and any concomitant sleep pathologies. Treatment of parasomnias involves a combined approach of pharmacological and non-pharmacological intervention, including safety measures, sleep hygiene and medicines such as clonazepam or melatonin to improve sleep consolidation and reduce behavioural activity. As parasomnias can not only be disruptive for the patient and their bed-partner but have important prognostic or forensic consequences, an understanding of their pathophysiology, clinical features and management is valuable for any respiratory physician who may encounter them. Educational aims To understand the common features of NREM and REM parasomnias.To differentiate between the causes of motor behaviours during sleep.To discuss the treatment approach for NREM and REM parasomnias.
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Affiliation(s)
- Imran Johan Meurling
- Sleep Disorders Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK,Corresponding author: Imran Johan Meurling ()
| | - Guy Leschziner
- Sleep Disorders Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK,Plasticity Centre, Dept of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK,Dept of Neurology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Panagis Drakatos
- Sleep Disorders Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK,Faculty of Life Sciences and Medicine, King's College London, London, UK
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31
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Sleep and Epilepsy. Neurol Clin 2022; 40:769-783. [DOI: 10.1016/j.ncl.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Lu J, Zhao G, Lv D, Cao L, Zhao G. Autosomal dominant sleep-related hypermotor epilepsy associated with a novel mutation of KCNT1. Transl Neurosci 2022; 13:240-245. [PMID: 36117860 PMCID: PMC9438967 DOI: 10.1515/tnsci-2022-0241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Autosomal dominant sleep-related hypermotor epilepsy (ADSHE) is characterized by severe sleep-related rigid hypermotor seizures. The pathogenic genes of ADSHE include genes encoding subunits of the neuronal nicotinic acetylcholine receptor, KCNT1, DEPDC5, NPRL2/3, CABP4, and CRH. Individuals with KCNT1-related ADSHE are more likely to develop seizures at a younger age, have cognitive comorbidity, and display psychiatric and behavioral problems. In this study, a 12-year-old Chinese girl was referred for genetic evaluation of grand mal seizures. She had paroxysmal convulsions of the limbs and loss of consciousness just after falling asleep without obvious triggers. A novel heterozygous missense mutation c.2797C > T (p.Arg933Cys) in exon 24 of the KCNT1 was identified in the proband by whole-exome sequencing and Sanger sequencing, and the clinical symptoms were compatible with ADSHE. The proband’s father has been showing similar symptoms for more than 20 years and had the same site mutation. Her mother and sister were physically and genetically normal. The study revealed a novel variant in the KCNT1 and expanded the mutation spectrum for this clinical condition. Our results provide further evidence supporting a causative role in KCNT1 variants in ADSHE.
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Affiliation(s)
- Jinyu Lu
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine , Yiwu , China
| | - Gaohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine , Yiwu , China
| | - Dayao Lv
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine , Yiwu , China
| | - Lanxiao Cao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine , Yiwu , China
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine , Yiwu , China
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33
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Kokkinos V, Koupparis AM, Koutroumanidis M, Kostopoulos GK. Editorial: Brain Mechanisms Linking Sleep and Epilepsy. Front Hum Neurosci 2022; 16:922372. [PMID: 35620153 PMCID: PMC9128402 DOI: 10.3389/fnhum.2022.922372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Vasileios Kokkinos
| | | | - Michalis Koutroumanidis
- Department of Clinical Neurophysiology and Epilepsies, Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - George K. Kostopoulos
- Neurophysiology Unit, Department of Physiology, Medical School, University of Patras, Patras, Greece
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34
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Riney K, Bogacz A, Somerville E, Hirsch E, Nabbout R, Scheffer IE, Zuberi SM, Alsaadi T, Jain S, French J, Specchio N, Trinka E, Wiebe S, Auvin S, Cabral-Lim L, Naidoo A, Perucca E, Moshé SL, Wirrell EC, Tinuper P. International League Against Epilepsy classification and definition of epilepsy syndromes with onset at a variable age: position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1443-1474. [PMID: 35503725 DOI: 10.1111/epi.17240] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 01/15/2023]
Abstract
The goal of this paper is to provide updated diagnostic criteria for the epilepsy syndromes that have a variable age of onset, based on expert consensus of the International League Against Epilepsy Nosology and Definitions Taskforce (2017-2021). We use language consistent with current accepted epilepsy and seizure classifications and incorporate knowledge from advances in genetics, electroencephalography, and imaging. Our aim in delineating the epilepsy syndromes that present at a variable age is to aid diagnosis and to guide investigations for etiology and treatments for these patients.
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Affiliation(s)
- Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - Alicia Bogacz
- Institute of Neurology, University of the Republic, Montevideo, Uruguay
| | - Ernest Somerville
- Prince of Wales Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Edouard Hirsch
- Francis Rohmer Epilepsy Unit, Hautepierre Hospital, Strasbourg, France.,National Institute of Health and Medical Research 1258, Strasbourg, France.,Federation of Translational Medicine of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Assistance Publique - Hôpitaux de Paris, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Member of Epicare, Paris, France.,Imagine Institute, National Institute of Health and Medical Research Mixed Unit of Research 1163, Paris, France.,University City University, Paris, France
| | - Ingrid E Scheffer
- Austin Health, Royal Children's Hospital, Florey Institute and Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Sameer M Zuberi
- University City University, Paris, France.,Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | | | - Jacqueline French
- New York University Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, member of EpiCARE, Rome, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria.,Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Stéphane Auvin
- Institut Universitaire de France, Paris, France.,Paediatric Neurology, Assistance Publique - Hôpitaux de Paris, Robert-Debré Hospital, Paris, France.,University of Paris, Paris, France
| | - Leonor Cabral-Lim
- Department of Neurosciences, College of Medicine and Philippine General Hospital, Health Sciences Center, University of the Philippines Manila, Manila, the Philippines
| | - Ansuya Naidoo
- Neurology Unit, Greys Hospital, Pietermaritzburg, South Africa.,Department of Neurology, University of KwaZulu Natal, KwaZulu Natal, South Africa
| | - Emilio Perucca
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine, New York, New York, USA.,Montefiore Medical Center, Bronx, New York, USA
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Reference Centre for Rare and Complex Epilepsies, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
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35
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High frequency oscillations play important roles in development of epileptogenesis/ictogenesis via activation of astroglial signallings. Biomed Pharmacother 2022; 149:112846. [PMID: 35325849 DOI: 10.1016/j.biopha.2022.112846] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022] Open
Abstract
To explore developmental processes of epileptogenesis/ictogenesis and pathophysiology of carbamazepine-resistant epilepsy, we determined effects of high-frequency-oscillation (HFO) on glutamatergic tripartite-synaptic transmission, astroglial expression of connexin43, and intracellular Erk- and Akt-signalling, using genetic rat model (S286L-TG) of autosomal-dominant sleep-related hypermotor epilepsy(ADSHE), which bears rat S286L-mutant Chrna4(corresponding to human S284L-mutant CHRNA4). Artificial physiological ripple- and pathological fast-ripple-burst stimulations use-dependently increased L-glutamate release through connexin43-containing hemichannels by enhancing Erk-signalling alone or both ERK- and Akt-signalling together, respectively. Stimulatory effects of HFO-bursts on astroglial L-glutamate release were enhanced by increasing extracellular K+ levels, Akt- and Erk-signalling-dependently. HFO-bursts also activated connexin43 expression and Akt- and Erk-signallings use-dependently. Extracellular pH elevation enhanced HFO-burst-evoked astroglial L-glutamate release, which was suppressed by therapeutically-relevant concentration of zonisamide via possible carbonic-anhydrase inhibition, but not by that of carbamazepine. Unexpectedly, these responses of S286L-TG to HFO-bursts were almost equal to those of wild-type astrocytes. These results indicated that candidate pathomechanism/pathophysiology of carbamazepine-resistant ADSHE, which enhanced HFO-bursts in S286L-TG neurons may contribute to epileptogenesis/ictogenesis development via activation of connexin43-associated astroglial transmission, which was directly unaffected by mutation, and induced through activated Erk-signalling, followed by Akt-signalling. Therefore, suppression of overexpressed Erk-signalling probably prevents ADSHE onset via indirect inhibition of mutant CHRNA4-associated pathomechanistic developments.
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Meneghini S, Modena D, Colombo G, Coatti A, Milani N, Madaschi L, Amadeo A, Becchetti A. The β2V287L nicotinic subunit linked to sleep-related epilepsy differently affects fast-spiking and regular spiking somatostatin-expressing neurons in murine prefrontal cortex. Prog Neurobiol 2022; 214:102279. [DOI: 10.1016/j.pneurobio.2022.102279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
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Higgins S, Koutroumanidis M. Psychogenic non-epileptic seizures arising almost exclusively from sleep. Seizure 2022; 99:43-47. [DOI: 10.1016/j.seizure.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/15/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
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Samanta D. DEPDC5-related epilepsy: A comprehensive review. Epilepsy Behav 2022; 130:108678. [PMID: 35429726 DOI: 10.1016/j.yebeh.2022.108678] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
DEPDC5-related epilepsy, caused by pathogenic germline variants(with or without additional somatic variants in the brain) of DEPDC5 (Dishevelled, Egl-10 and Pleckstrin domain-containing protein 5) gene, is a newly discovered predominantly focal epilepsy linked to enhanced mTORC1 pathway. DEPDC5-related epilepsy includes several familial epilepsy syndromes, including familial focal epilepsy with variable foci (FFEVF) and rare sporadic nonlesional focal epilepsy. DEPDC5 has been identified as one of the more common epilepsy genes linked to infantile spasms and sudden unexpected death (SUDEP). Although intelligence usually is unaffected in DEPDC5-related epilepsy, some people have been diagnosed with intellectual disabilities, autism spectrum disorder, and other psychiatric problems. DEPDC5 variants have also been found in 20% of individuals with various brain abnormalities, challenging the traditional distinction between lesional and nonlesional epilepsies. The most exciting development of DEPDC5 variants is the possibility of precision therapeutics using mTOR inhibitors, as evidenced with phenotypic rescue in many animal models. However, more research is needed to better understand the functional impact of diverse (particularly missense or splice-region) variants, the specific involvement of DEPDC5 in epileptogenesis, and the creation and utilization of precision therapies in humans. Precision treatments for DEPDC5-related epilepsy will benefit not only a small number of people with the condition, but they will also pave the way for new therapeutic approaches in epilepsy (including acquired epilepsies in which mTORC1 activation occurs, for example, post-traumatic epilepsy) and other neurological disorders involving a dysfunctional mTOR pathway.
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Affiliation(s)
- Debopam Samanta
- Child Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
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Jiang YL, Song CG, Zhou HM, Feng B, Zhao JJ, Liu Y, Man YL, Han J, Liu SB, Jiang W. Rare variants in GABRG2 associated with sleep-related hypermotor epilepsy. J Neurol 2022; 269:4939-4954. [PMID: 35486215 DOI: 10.1007/s00415-022-11137-4] [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: 02/12/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
Sleep-related hypermotor epilepsy (SHE) is a focal epilepsy syndrome. The underlying pathophysiology is presumed to be closely related with disruption of GABAergic neurotransmission, which is mainly medicated by γ-aminobutyric acid type A receptor (GABAAR). Thus, it is reasonable to assume that rare GABAAR variants might contribute to the pathogenesis of SHE. To test this hypothesis, we performed next-generation sequencing in 58 SHE patients and analyzed the functional effects of the identified variants in both neuronal and non-neuronal cells using a combination of electrophysiology recordings, western blot, flow cytometry, and confocal microscopy. In our study, we detected three rare variants (NM_198904.2: c.269C > T, p.T90M; NM_198904.2: c.950C > A, p.T317N and NM_198903.2: c.649C > T, p.Q217X) in GABRG2 (MIM:137,164, encoding GABAAR γ2 subunit) in three unrelated patients. Two of the three rare variants were transmitted unaffected maternally (T90M) or unaffected paternally (Q217X), whereas the T317N variant arose de novo. The mother of proband carrying the T90M variant was unaffected and being mosaicism for this variant. Functional analysis showed that T90M and T317N variants decreased GABA-evoked current amplitudes by diverse mechanisms including impaired surface expression, endoplasmic reticulum retention, and channel gating defects. And Q217X variant reduced synaptic clustering and distribution of GABAAR. While a causal role of these variants cannot be established directly from these results, the functional assessment together with the genetic sequencing suggests that these rare GABRG2 variants may constitute genetic risk factors for SHE. Our study further expands the GABRG2 phenotypic spectrum and supports the view that GABAergic neurotransmission participates in the epileptogenesis of SHE.
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Affiliation(s)
- Yong-Li Jiang
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Chang-Geng Song
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Hui-Min Zhou
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Ban Feng
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China
| | - Jing-Jing Zhao
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Yu Liu
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Yu-Lin Man
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Jing Han
- MOE Key Laboratory of Modern Teaching Technology, Center for Teacher Professional Ability Development, Shaanxi Normal University, 199 South Chang'an Road, Xi'an, China.
| | - Shui-Bing Liu
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an, China.
| | - Wen Jiang
- Comprehensive Epilepsy Center, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.
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Nobili L, Frauscher B, Eriksson S, Gibbs SA, Halasz P, Lambert I, Manni R, Peter-Derex L, Proserpio P, Provini F, de Weerd A, Parrino L. Sleep and epilepsy: A snapshot of knowledge and future research lines. J Sleep Res 2022; 31:e13622. [PMID: 35487880 PMCID: PMC9540671 DOI: 10.1111/jsr.13622] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Sleep and epilepsy have a reciprocal relationship, and have been recognized as bedfellows since antiquity. However, research on this topic has made a big step forward only in recent years. In this narrative review we summarize the most stimulating discoveries and insights reached by the "European school." In particular, different aspects concerning the sleep-epilepsy interactions are analysed: (a) the effects of sleep on epilepsy; (b) the effects of epilepsy on sleep structure; (c) the relationship between epilepsy, sleep and epileptogenesis; (d) the impact of epileptic activity during sleep on cognition; (e) the relationship between epilepsy and the circadian rhythm; (f) the history and features of sleep hypermotor epilepsy and its differential diagnosis; (g) the relationship between epilepsy and sleep disorders.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatric Unit, Istituto G. Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sofia Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Steve Alex Gibbs
- Department of Neurosciences, Center for Advanced Research in Sleep Medicine, Sacred Heart Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Isabelle Lambert
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.,APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, CNRS UMR 5292/INSERM U1028, Lyon, France
| | - Paola Proserpio
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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Abstract
PURPOSE OF REVIEW This article reviews the clinical features, typical EEG findings, treatment, prognosis, and underlying molecular etiologies of the more common genetic epilepsy syndromes. Genetic generalized epilepsy, self-limited focal epilepsy of childhood, self-limited neonatal and infantile epilepsy, select developmental and epileptic encephalopathies, progressive myoclonus epilepsies, sleep-related hypermotor epilepsy, photosensitive occipital lobe epilepsy, and focal epilepsy with auditory features are discussed. Also reviewed are two familial epilepsy syndromes: genetic epilepsy with febrile seizures plus and familial focal epilepsy with variable foci. RECENT FINDINGS Recent years have seen considerable advances in our understanding of the genetic factors underlying genetic epilepsy syndromes. New therapies are emerging for some of these conditions; in some cases, these precision medicine approaches may dramatically improve the prognosis. SUMMARY Many recognizable genetic epilepsy syndromes exist, the identification of which is a crucial skill for neurologists, particularly those who work with children. Proper diagnosis of the electroclinical syndrome allows for appropriate treatment choices and counseling regarding prognosis and possible comorbidities.
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Menghi V, Bisulli F, Cardinale F, Vignatelli L, Zenesini C, Mai R, Proserpio P, Francione S, Sartori I, Tinuper P, Nobili L. Predictors of hyperkinetic seizures. Epilepsy Behav 2022; 129:108629. [PMID: 35272206 DOI: 10.1016/j.yebeh.2022.108629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify predisposing factors for hyperkinetic seizure occurrence in a representative cohort of surgically treated patients with drug-resistant focal epilepsy. METHODS We retrospectively recruited all seizure-free patients after epilepsy surgery with a postoperative follow-up ≥12 months. Patients were classified as presenting with hyperkinetic seizures if at least 2 episodes occurred during their disease history, based on clear-cut anamnestic description and/or video-EEG/stereo-EEG recordings. We performed univariable and multivariable logistic regression models to study the association between the occurrence of hyperkinetic seizures and some predictors. RESULTS From a pool of 1758 consecutive patients who underwent surgery from 1996 to 2017, we identified 974 seizure-free cases. Considering at least 1-year follow-up, 937 cases were included (511 males, 91 patients with hyperkinetic seizures). Variables significantly associated with an increased risk of hyperkinetic seizure occurrence were (1) presence of epilepsy with sleep-related seizures (SRE) (P < 0.001); (2) histological diagnosis of type II focal cortical dysplasia (FCD) (P < 0.001); (3) resection including the frontal lobe (P = 0.002) (4) duration of epilepsy at surgery (P < 0.001) and (5) high seizure frequency at surgery (weekly: P = 0.02 - daily: P = 0.05). A resection including the occipital lobe reduced the risk of hyperkinetic seizures (P = 0.05). About 63% of patients had hyperkinetic seizure onset before 12 years and it was rarely reported before 5 years of age. SIGNIFICANCE Our findings underlie the role of SRE, type II FCD and frontal epileptogenic zone as predictors of hyperkinetic seizure occurrence and highlight an age-dependent effect in favoring hyperkinetic manifestations.
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Affiliation(s)
- Veronica Menghi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; Neurology Unit, Rimini "Infermi" Hospital-AUSL Romagna, Rimini, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | | | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | - Roberto Mai
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Paola Proserpio
- Centre of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | | | - Ivana Sartori
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | - Lino Nobili
- IRCCS, Child Neuropsychiatry, Istituto G. Gaslini, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy; DINOGMI, University of Genoa, Genoa, Italy.
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Arenas-Cabrera C, Baena-Palomino P, Sánchez-García J, Oliver-Romero M, Chocrón-González Y, Caballero-Martínez M. Sleep-related hypermotor epilepsy with genetic diagnosis: description of a case series in a tertiary referral hospital. J Cent Nerv Syst Dis 2022; 14:11795735211060114. [PMID: 35177946 PMCID: PMC8844731 DOI: 10.1177/11795735211060114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Sleep-related hypermotor epilepsy (SHE) is characterized by asymmetric tonic/dystonic posturing and/or complex hyperkinetic seizures occurring mostly during sleep. Experts agree that SHE should be considered a unique syndrome. PURPOSE We present 8 cases of SHE for which a genetic diagnosis was carried out using a multigene epilepsy panel. Methods We retrospectively screened familial and isolated cases of SHE in current follow-ups in our center. Results We included 8 (5F/3M) patients, 5 of whom had a positive familial history of epilepsy. We identified a pathogenic mutation in CHRNA4, CHRNB2, and 3 different pathogenic changes in DEPDC5. Conclusions Awareness of SHE needs to be raised, given its implications for finding an appropriate treatment, its relationship to cognitive and psychiatric comorbidities, and the opportunity to prevent the disorder in the descendants. We present our series with their clinical, radiological, electroencephalographic, and genetic characteristics, in which we found 3 pathogenic mutations in the DEPDC5 gene but not previously reported in the literature. Identifying new pathogenic mutations or new genes responsible for SHE will facilitate a better understanding of the disease and a correct genetic counseling.
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Affiliation(s)
| | | | - Javier Sánchez-García
- Department of Genetics, Reproduction and Fetal Medicine, Institute of Biomedicine of Sevilla (IBIS), University Hospital Virgen Del Rocío/CSIC/University of Sevilla, Centre for Biomedical Network Research on Rare Diseases (CIBERER), Sevilla, Spain
| | - María Oliver-Romero
- Department of Neurosurgery, University Hospital Virgen Del Rocío, Sevilla, Spain
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Wang Y, He C, Chen C, Wang Z, Ming W, Qiu J, Ying M, Chen W, Jin B, Li H, Ding M, Wang S. Focal cortical dysplasia links to sleep-related epilepsy in symptomatic focal epilepsy. Epilepsy Behav 2022; 127:108507. [PMID: 34968776 DOI: 10.1016/j.yebeh.2021.108507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In sleep-related epilepsy (SRE), epileptic seizures predominantly occur during sleep, but the clinical characteristics of SRE remain elusive. We aimed to identify the clinical features associated with the occurrence of SRE in a large cohort of symptomatic focal epilepsy. METHODS We retrospectively included patients with four etiologies, including focal cortical dysplasia (FCD), low-grade tumors (LGT), temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), and encephalomalacia. SRE was defined as more than 70% of seizures occurring during sleep according to the seizure diary. The correlation between SRE and other clinical variables, such as etiology of epilepsy, pharmacoresistance, seizure frequency, history of bilateral tonic-clonic seizures, and seizure localization was analyzed. RESULTS A total of 376 patients were included. Among them 95 (25.3%) were classified as SRE and the other 281(74.7%) as non-SRE. The incidence of SRE was 53.5% in the FCD group, which was significantly higher than the other three groups (LGT: 19.0%; TLE-HS: 9.9%; encephalomalacia: 16.7%; P < 0.001). The etiology of FCD (p < 0.001) was significantly associated with SRE (OR: 9.71, 95% CI: 3.35-28.14) as an independent risk factor. In addition, small lesion size (p = 0.009) of FCD further increased the risk of SRE (OR: 3.18, 95% CI: 1.33-7.62) in the FCD group. SIGNIFICANCE Our data highlight that FCD markedly increased the risk of sleep-related epilepsy independently of seizure localization. A small lesion of FCD further increased the risk of sleep-related epilepsy by 2.18 times in the FCD group.
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Affiliation(s)
- Yunling Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Chenmin He
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhongjin Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenjie Ming
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingjing Qiu
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ying
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Chen
- Department of Neurology, Linhai Second People's Hospital, Taizhou, China
| | - Bo Jin
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Hong Li
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Disorders of arousal and sleep-related hypermotor epilepsy - overview and challenges night is a battlefield of sleep and arousal promoting forces. Neurol Sci 2022; 43:927-937. [PMID: 34984571 DOI: 10.1007/s10072-021-05857-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
Arousability and reactivity to sensory stimuli are essential features of sleep, discriminating it from coma and keeping the sleeper in contact with the environment. Arousals and oscillations during sleep serve the reversibility of sleep and carry an alarm function awakening the sleeper in danger. In this review, we will explore mechanisms and circuits involved in arousal intrusions within the sleep texture, focusing on the significance of these phenomena in two sleep-related conditions: NREM sleep parasomnias and sleep-related hypermotor epilepsy. Knowledges and gaps in the field are discussed.
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Nielsen TØ, Herlin MK, Linnet KM, Beniczky S, Sommerlund M, Granild-Jensen JB, Gregersen PA. Autosomal dominant sleep-related hypermotor epilepsy caused by a previously unreported CHRNA4 variant. Eur J Med Genet 2022; 65:104444. [DOI: 10.1016/j.ejmg.2022.104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 11/03/2022]
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Li Y, Zhao X, Wang S, Xu K, Zhao X, Huang S, Zhu S. A Novel Loss-of-Function Mutation in the NPRL3 Gene Identified in Chinese Familial Focal Epilepsy with Variable Foci. Front Genet 2021; 12:766354. [PMID: 34868250 PMCID: PMC8633433 DOI: 10.3389/fgene.2021.766354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Familial focal epilepsy with variable foci is an autosomal dominant disorder characterized by partial epilepsy with variable foci. In this study, we report a six-generation with segregation of the mutation present in four generations Chinese family presenting with focal epilepsy with variable foci. Whole exome sequencing confirms a novel pathogenic mutation in the NPRL3 gene (c316C>T; p. Q106*). PCR, Western blotting, and immunohistochemistry were conducted to analyze the gene transcription, protein expression, and subcellular localization of NPRL3 and related signaling molecules in peripheral blood cells from family members. As compared with healthy family members, both mRNA level and protein expression of NPRL3 are decreased in peripheral blood cells of the mutation carrier. In addition, the expression of downstream molecular Phospho-p70 S6 kinase (P-s6k) are increased consequently. Our findings expand the genotypic and phenotypic spectrum of the NPRL3-associated epilepsy and reveal the mechanisms of mTOR pathway signaling and GATOR1 pathogenesis in focal epilepsies, providing exciting potential for future diagnostic and therapeutic interventions. However, further in vitro and animal experiments are still needed to evaluate the role of NPRL3 loss-of-function mutation in epileptogensis.
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Affiliation(s)
- Youzhi Li
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Zhao
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Wang
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Xu
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zhao
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Precision treatment with nicotine in autosomal dominant sleep-related hypermotor epilepsy (ADSHE): An observational study of clinical outcome and serum cotinine levels in 17 patients. Epilepsy Res 2021; 178:106792. [PMID: 34763266 DOI: 10.1016/j.eplepsyres.2021.106792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/20/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the clinical outcome of nicotine exposure in patients with autosomal dominant sleep-related hypermotor epilepsy (ADSHE), along with serum concentrations of the major nicotine metabolite cotinine. METHODS We recruited 17 ADSHE patients with CHRNA4 mutations (12 with p.S280F and 5 with p.L291 dup). Clinical characteristics were collected from hospital records. A telephone interview was performed on the use and seizure-reducing effect of nicotine applying a six-point rating scale from "none" to very good". Serum concentrations of cotinine were measured in 14 nicotine users. RESULTS All patients but one had ever used nicotine. Nine had used snuff; seven were current users. Eleven had used transdermal nicotine; nine were current users. Seven reported long-lasting seizure control, all used nicotine, four transdermal nicotine and three snuff. In 78% of patients using continuous transdermal nicotine, the effect was rated as good or very good. Cotinine concentrations were 453 ± 196 (mean ± SD) nmol/l in seven patients using transdermal nicotine only vs. 1241 ± 494 nmol/l in seven using other forms of nicotine. No correlation with seizure control was found. Three patients experienced improvement with transdermal delivery compared to snuff. CONCLUSION This is the hitherto largest observational study supporting a favorable effect of nicotine in this specific seizure disorder. Better seizure control from transdermal nicotine compared to only day-time consumption suggests benefit from exposure throughout the night. According to current clinical experience, patients with uncontrolled ADSHE harboring relevant mutations should be offered precision treatment with transdermal nicotine.
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Morkous SS. A 16-Year-Old Male With Frequent Nocturnal Events During Slow Wave Sleep on a Polysomnogram. Cureus 2021; 13:e18047. [PMID: 34692279 PMCID: PMC8523337 DOI: 10.7759/cureus.18047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
A 16-year-old male was referred by the primary care physician (PCP) for a second opinion. An initial evaluation in another sleep center suggested a working diagnosis of night terrors for the last two years. The child would wake up frequently screaming for few minutes before going back to sleep with no recollection of these events later. A video during the polysomnography (PSG) showed the patient having one of his typical events. He was eventually diagnosed with Sleep-related Hypermotor Epilepsy (SHE) seizures. This case highlights the importance of differentiating parasomnia and seizures, particularly for the sleep medicine providers that incorporate providers from different academic backgrounds. We will discuss the clinical challenges to make the distinction for the referring providers and demonstrate the importance of video-PSG to establish the diagnosis.
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Affiliation(s)
- Sameh S Morkous
- Pediatric Neurology, Lehigh Valley Health Network (LVHN) Lehigh Valley Reilly Children's Hospital, Allentown, USA
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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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