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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over the past two to three decades, sleep medicine has emerged as an important discipline as it strives to meet the challenges of some of the most prevalent disorders among humans. Among the 110 disorders listed in the International Classification of Sleep Disorders, two of the most prevalent and treatable have only recently begun to receive significant attention: sleep apnea and restless legs syndrome with sleep-related periodic limb movements disorder. It is becoming clear that the sleep disruption caused by such disorders has ramifications beyond the usually associated daytime sleepiness, and may include: exacerbation of seizures, headaches, short-term memory deficits, and other cognitive problems. Sleep apnea has also been correlated with hypertension and cardiovascular/cerebrovascular disease. Animal studies have taken this one step further by demonstrating that total sleep deprivation is consistently fatal, usually within 1 month, although the precise mechanism remains to be discovered. The most compelling finding in the animal studies is that "rescuing" the animals with sleep, before the irreversible stage, is associated with rebound amounts of deep sleep and rapid eye movement (REM) sleep ("dream sleep"). This same response is seen after initiating treatment of sleep apnea with nasal continuous positive airway pressure (CPAP), and can also occur in patients with other sleep disorders in response to particular medications, such as valproate or gabapentin.
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PMID:Importance of sleep restoration in co-morbid disease: effect of anticonvulsants. 1071 82

Sleep disturbance in patients with epilepsy is frequently overlooked, but may contribute to decreased daytime functioning and increased seizure activity. Although complicated, the relationship between sleep and epilepsy is becoming clearer. Sleep, and particularly deep non-rapid-eye-movement sleep, increase interictal epileptiform activity. Sleep increases certain seizure types and the rate of generalization of partial seizures, however rapid-eye-movement sleep seems to suppress seizures. Sleep disorders, particularly sleep apnea, exacerbate seizures. Seizures, in turn, can disrupt sleep structure, particularly rapid-eye-movement sleep. An understanding of these relationships is important in seizure control and in maximizing the quality of life for patients with epilepsy.
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PMID:Sleep and epilepsy. 1098 75

Video-electroencephalography (EEG) telemetry is a crucial component in the comprehensive evaluation of patients with epilepsy. The reasons for patients needing to be monitored fall broadly into three groups: presurgical assessment (36% of our patients), diagnostic assessment (52%), and sleep disorders (12%). Video EEG can be used to differentiate unusual epilepsies from pseudo seizures or other causes of paroxysmal neurological events. The design of a unit depends on the case mix of patients expected to be referred. The key elements to a successful unit are a reliable, flexible, easy-to-use recording system and a team of dedicated, experienced staff, both nursing and technical. The unit at the National Hospital is a six-bed ward with 7 nurses to provide 24-hour coverage, 5 technicians working in shifts, and physics support. A minimum of two staff are on duty at all times. It operates on a five-day week with a throughput of approximately 500 patients per year. It is vital that investigations are performed as efficiently and effectively as possible, and the patient's safety and wellbeing is paramount at all times. Drug reduction is likely to be used to precipitate seizures, especially in those being considered for epilepsy surgery, and this poses a risk of provoked secondary generalized seizures. Continuous supervision of patients, and the ability to respond rapidly to a seizure, are therefore essential. We adopt a standardized easy-to-follow drug-reduction protocol, similar to that used by other centers.
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PMID:Design of an intensive epilepsy monitoring unit. 1104 33

Melatonin, which is used to treat sleep disorders, has anticonvulsant properties. The authors measured salivary melatonin and cortisol, at baseline and following seizures, in patients with intractable temporal lobe epilepsy and controls. Melatonin was reduced in patients with epilepsy at baseline compared with controls, and increased threefold following seizures. Cortisol also increased following seizures. Patients with intractable epilepsy have low baseline melatonin levels that increase dramatically following seizures.
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PMID:Patients with intractable epilepsy have low melatonin, which increases following seizures. 1111 38

(1) Loss of efficacy can occur after a few weeks of treatment with zolpidem and zopiclone. This is not a reason to increase the dose. (2) Zolpidem and zopiclone carry a risk of dependence and of potentially severe disorders (e.g. seizures) during withdrawal. (3) The risk-benefit ratio of benzodiazepines and related drugs (zopiclone and zolpidem) remains more favourable than that of other drugs used in insomnia. However, first-line treatment of sleep disorders should not necessarily be drug-based.
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PMID:Hypnotic dependence: zolpidem and zopiclone too. 1150 51

Long-term electroencephalographic monitoring (LTM) is the capability of recording the EEG over long periods of time and not a specific duration. Prolonged EEG recording is used primarily for epilepsy monitoring, but LTM is also used in the intensive care unit, the operating room, and in the emergency department. The purpose of LTM is to expand the limited time sampling associated with shorter "routine" EEG recording. Audiovisual monitoring may also be used in conjunction with LTM to evaluate simultaneously a specific clinical behavior that may or may not be associated with EEG alteration. This is typically performed in a hospital setting for safety and ancillary testing purposes. LTM is used most frequently in the diagnosis and management of seizures and "spells," but has also gained wider application in the evaluation of sleep disorders, cerebrovascular disease, psychiatric conditions, and movement disorders. Computer-assisted LTM systems that process, analyze, compress, and store data digitally have become widely available in clinical practice both in the hospital as well as outside the hospital when the patient is ambulatory.
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PMID:Long-term EEG monitoring: a clinical approach to electrophysiology. 1170 50

Epilepsy and sleep are intricately associated. Influences of epilepsy on sleep as a result of drug treatment and the vigilance altering effects thereof as well as the temporal distribution and presentation of seizures are considered. The effect of sleep quality on seizure frequency is well known and must play a part in the management of patients with epilepsy. A careful scrutiny of potential sleep disturbing factors such as primary sleep disorders is equally important to the successful management of seizure frequency and of excessive daytime somnolence, which may be a confounding comorbidity in this patient population. The occasionally difficult differential diagnosis of epilepsy and parasomnias is a field in which an interdisciplinary approach between epileptologists and sleep specialists is necessary, video-EEG-polysomnography being an indispensable diagnostic instrument.
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PMID:[Epilepsy and sleep]. 1181 59

Seizures and antiepileptic drugs (AEDs) affect sleep macroarchitecture and may produce excessive daytime sleepiness (EDS) in patients with epilepsy. Sleep is a potent activator of seizures and epileptiform discharges. In some patients, seizures occur exclusively or predominately in sleep. Benign focal epilepsy of childhood with centrotemporal spikes (BECTS), supplementary sensorimotor area epilepsy (SSMA) and Lennox Gastaut syndrome are a few of the more common epilepsy syndromes characterized by nocturnal seizures. Excessive daytime sleepiness is a common complaint of patients with epilepsy. Causes of EDS include seizures, AEDs, poor sleep hygiene, and coexisting sleep disorders. Pharmacologic therapy is aimed at identifying the single most effective drug for a given seizure type or epilepsy syndrome. Polytherapy is associated with a higher likelihood of adverse effects--most notably, EDS. Poor sleep hygiene leads to sleep fragmentation that can exacerbate seizures and EDS. Primary sleep disorders should be suspected in patients with EDS, particularly those treated with monotherapy at low serum drug concentrations and well controlled seizures. Treatment of sleep disorders may lead to better seizure control.
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PMID:Sleep and Epilepsy. 1182 45

Prolactin releasing peptide (PrRP) is a recently identified neuropeptide that stimulates prolactin release from pituitary cells. The presence of its receptor outside the hypothalamic-pituitary axis suggests that it may have other functions. We present here evidence that PrRP can modulate the activity of the reticular thalamic nucleus, a brain region with prominent PrRP receptor expression that is critical for sleep regulation and the formation of non-convulsive absence seizures. Intracerebroventricular injection of PrRP (1-10 nmol) into sleeping animals significantly suppresses sleep oscillations and promotes rapid and prolonged awakening. Higher concentrations of PrRP (10-100 nmol) similarly suppress spike wave discharges seen during absence seizures in genetic absence epilepsy rats from Strasbourg, an animal model for this disorder. In concordance with these findings, PrRP suppressed evoked oscillatory burst activity in reticular thalamic slices in vitro. These results indicate that PrRP modulates reticular thalamic function and that activation of its receptor provides a new target for therapies directed at sleep disorders and absence seizures.
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PMID:Prolactin-releasing peptide (PrRP) promotes awakening and suppresses absence seizures. 1220 68

The category of common sleep disorders known as parasomnias includes disorders of arousal, rapid eye movement (REM) sleep behaviour disorder (RBD), nocturnal seizures, rhythmic movement disorder, and tooth grinding or 'bruxism'. Parasomnias are all characterised as undesirable physical or behavioural phenomena occurring during the sleep period. Although these conditions can be distressing and, in some cases, hazardous to the sleeper and his or her bed partner, it is important to recognise that parasomnias are diagnosable and treatable in the vast majority of patients. Evaluation begins with a careful clinical interview with the sleeper and a family member to elucidate the frequency, duration, description and timing after sleep onset of these behavioural events. Disorders of arousal are the most common type of parasomnia and cover a spectrum from calm sleepwalking to emotionally agitated or complex behaviours, such as dressing or driving, for which the patient usually has no memory upon awaking. 'Sleep terrors' are quite common in young children and are often outgrown. Disorders of arousal represent a partial, as opposed to a full, awakening from deep non-REM sleep, typically occurring within the first 60 to 90 minutes after sleep onset. RBD is characterised clinically by a history of dream-enacting behaviour, and the patient may recall dream content. REM sleep periods typically occur in the latter half of the night. Physiologically, RBD results from a lack of the normal muscle atonia that is associated with REM sleep. RBD has been linked to a number of other neurological conditions; thus, a careful review of systems and a physical examination are crucial. A formal laboratory sleep study or polysomnogram with an expanded electroencephalographic montage can help distinguish among non-REM and REM parasomnias and nocturnal seizures. The latter may manifest clinically as arousals from sleep associated with vocalisation and/or complex behaviours. Rhythmic movement disorder can include head banging or body rocking at sleep onset or during the night. Tooth grinding is a common sleep-related behaviour that, when severe, can result in dental injury. Hypnagogic hallucinations (experience of dream imagery at sleep onset) and sleep-onset paralysis (experience of muscle/body paralysis as one is falling asleep) are symptoms rather than diagnostic categories. These phenomena classically occur in many individuals with narcolepsy, but also may occur in healthy sleep-deprived individuals. Safety precautions and good general sleep hygiene measures are recommended for individuals with a parasomnia, as the disorder can be exacerbated by sleep deprivation and various other factors. When the events are frequent or particularly dramatic, medication with a long- or medium-acting benzodiazepine, such as clonazepam, at bedtime is effective therapy in most cases of non-REM disorders of arousal and RBD. A dental guard may be helpful in tooth grinders. Relaxation training and guided imagery may be helpful strategies for some patients, especially those with disorders of arousal or rhythm movement disorders. There is no evidence of any association between parasomnias and psychiatric illness. Demystification of these conditions and reassurance, particularly for parents of paediatric patients, is an important aspect of clinical intervention.
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PMID:Parasomnias: epidemiology and management. 1242 Nov 14


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