Sign Up for a Free Account
  • Updated 06.06.2023
  • Released 06.05.2010
  • Expires For CME 06.06.2026

Impact of sleep on epileptic manifestations



The circadian, homeostatic, ultradian, and microstructural processes that regulate the sleep-wake cycle are endowed with modulatory properties on epileptic events. In particular, sleep is a powerful trigger of both ictal and interictal manifestations. Non-REM sleep and cyclic alternating pattern promote strong activating effects, although REM sleep tends to exert a more inhibitory action. REM sleep, due to its characteristic neural asynchrony that limits the propagation of interictal epileptiform discharges, may ease the localization of the seizure onset zone. Sleep microstructure is tightly linked with epileptiform phenomena. Coexistence of sleep disturbances worsen seizure control and lower quality of life in patients affected by epilepsy. Antiepileptic drugs may influence sleep architecture.

Key points

• Sleep is a powerful enhancer of epileptic features.

• Synchronized non-REM sleep facilitates seizures, whereas desynchronized REM sleep dampens seizure occurrence.

• The presence of nocturnal seizures affects the regular profile of the sleep architecture.

• Marked sleep instability, as expressed by cyclic alternating pattern (CAP), is often observed in epileptic patients, even in the absence of nocturnal seizures.

• Sleep-related seizures mostly affect conventional sleep measures, whereas nocturnal interictal discharges basically have a destabilizing impact on CAP parameters.

• Sleep is frequently altered in all forms of epilepsies (not only nocturnal epilepsies).

• Antiepileptic drugs might influence sleep both at macro and microstructure level.

Historical note and terminology

So far, sleep has been exploited by neurologists in clinical routine as a nontraumatic method to trigger EEG abnormalities in putative epileptic patients. Both non-REM (NREM) and REM sleep can disclose EEG discharges that remain silent in the wakefulness condition and, therefore, provide useful diagnostic information (04). However, sleep is not a passive neurophysiological state, but reflects highly dynamic processes that reciprocally interfere with the underlying mechanisms of epileptogenesis. This explains why epileptic manifestations can affect sleep and, in turn, be modulated by sleep itself. This reciprocal influence opens new perspectives on the interaction between epilepsy and the multiple biological processes that regulate the sleep-wake cycle. Moreover, the intrinsic properties of vigilance control can explain why a number of epileptic disorders, particularly nocturnal frontal lobe epilepsy, are confined exclusively in sleep.

Occurrence of epileptic phenomena during sleep is strongly modulated by the four major regulatory processes (circadian, homeostatic, ultradian, and microstructural).

This is an article preview.
Start a Free Account
to access the full version.

  • Nearly 3,000 illustrations, including video clips of neurologic disorders.

  • Every article is reviewed by our esteemed Editorial Board for accuracy and currency.

  • Full spectrum of neurology in 1,200 comprehensive articles.

  • Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink®, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660



ISSN: 2831-9125