Sleep-related epilepsy syndromes
- Erik K St Louis, MD, MS
Erik K St Louis, MD, MS
- Associate Professor of Neurology, Mayo Clinic College of Medicine
- Co-Director, Center for Sleep Medicine
- Departments of Neurology and Medicine, Mayo Clinic and Foundation
- Section Editors
- Alon Y Avidan, MD, MPH
Alon Y Avidan, MD, MPH
- Section Editor — Parasomnias and Sleep Related Movement Disorders
- Professor of Neurology
- David Geffen School of Medicine at UCLA
- Paul Garcia, MD
Paul Garcia, MD
- Section Editor — Epilepsy
- Professor of Neurology
- University of California, San Francisco
Epileptic seizures frequently manifest during the sleep state and are often difficult to distinguish from parasomnias and other nonepileptic events, particularly when seizures occur exclusively during sleep. While most epilepsies have a diurnal component (ie, seizures may occur during both sleep and wake), several epilepsy syndromes have an especially intimate and robust relationship with sleep.
This topic reviews the pathophysiology of seizures and epilepsy related to sleep and the clinical features, diagnosis, and treatment of common sleep-related epilepsy syndromes. The clinical features, diagnosis, and treatment of seizures and epilepsy more generally are reviewed elsewhere. (See "Evaluation and management of the first seizure in adults" and "Overview of the management of epilepsy in adults" and "Clinical and laboratory diagnosis of seizures in infants and children" and "Seizures and epilepsy in children: Classification, etiology, and clinical features" and "Seizures and epilepsy in children: Initial treatment and monitoring".)
EPIDEMIOLOGY AND CLASSIFICATION
Although the International League Against Epilepsy does not formally classify sleep-related epilepsies, in practice they can be divided into three major categories:
●Pure sleep epilepsies, in which seizures occur exclusively or predominantly during sleep (eg, benign epilepsy of childhood with centrotemporal spikes, nocturnal frontal lobe epilepsy) (see 'Benign focal epilepsies of childhood' below and 'Nocturnal (sleep-related) focal epilepsies' below)
●Sleep-accentuated epilepsies, in which seizures occur during both wakefulness and sleep but epileptiform activity is potentiated during sleep (eg, certain epileptic encephalopathies, including Lennox-Gastaut syndrome and Landau-Kleffner syndrome) (see 'Sleep-accentuated epilepsies' below)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EPIDEMIOLOGY AND CLASSIFICATION
- SLEEP AND EPILEPTOGENESIS
- BENIGN FOCAL EPILEPSIES OF CHILDHOOD
- NOCTURNAL (SLEEP-RELATED) FOCAL EPILEPSIES
- Etiology and genetics
- Clinical features
- - Nocturnal frontal lobe epilepsy
- - Nocturnal temporal lobe epilepsy
- - Nocturnal parietal or occipital lobe epilepsy
- Diagnostic evaluation
- Differential diagnosis
- - Patients with rare events and diagnostic uncertainty
- - Selection of antiseizure drug therapy
- - Prognosis and indications for referral
- - Supportive care and counseling
- Importance of adequate sleep
- Seizure precautions and risks
- SLEEP-ACCENTUATED EPILEPSIES
- AROUSAL EPILEPSIES
- SUMMARY AND RECOMMENDATIONS