Sleep and pediatric epilepsy
Dudley S. Dinner, MD
Section of Epilepsy and Clinical Neurophysiology, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195
THE very close relationship between sleep and epilepsy has been recognized since antiquity, as with Aristotle's observation that epilepsy often began during sleep. The most distinctive contribution, however, to the study of the relationship between epilepsy and the sleep-wake cycle was made by Janz in 1962.1 He studied the grand mal epilepsies and divided them, on the basis of their temporal relationship, into sleep epilepsies, wake epilepsies, and diffuse epilepsies (occurring during sleep or wakefulness). The effect of sleep and circadian fluctuations in vigilance on seizures is now well accepted. Sleep also has a significant effect on interictal epileptiform activity (IEA) in terms of its morphology and frequency; on the other hand, seizures may have a profound effect on sleep and its architecture.
This paper will discuss these interrelationships between sleep and epilepsy in pediatric patients and also the role of sleep and sleep deprivation as techniques in the electroencephalographic (EEG) recordings of patients with epilepsy.
GENERALIZED TONIC-CLONIC (GRAND MAL) EPILEPSY
Effect on seizures
Gowers,2 (1885) in a study of 840 patients, found seizures restricted to sleep in 21% of the group. Janz,1 (1962) in a study of 2110 “grand mal” epilepsy patients, found epilepsy restricted to sleep in 45%. Pure sleep-related epilepsy was found by Billiard3 in 28.5% of his cases. Gowers2 found a predominance of seizures in the first two hours of sleep or at the end of sleep. This pattern has been substantiated by several investigators. In Janz's study1 the two peaks were 9 to 11 PM. . .