RESUMEN
Epilepsy is the fourth most common neurologic disorde in the United States, affecting over 2.2 million people. Epilepsy is associated with a number of medical and psychiatric comorbidities, higher health-care use and cost, and substantial economic burden. OSA is twofold more common in adults with epilepsy than in age-matched control subjects, and the incidence increases with age. Self-reported daytime sleepiness is not helpful in predicting OSA, possibly related to the ceiling effect of general sleepiness among people with epilepsy from diverse causes. Mostly small retrospective series found a significant reduction in seizures in people with epilepsy and OSA adherent with positive airway pressure therapy compared with untreated individuals. This finding illustrates the potential beneficial effects of sleep therapies on epilepsy. Central apnea, oxygen desaturations, and hypercapnia can occur during the ictal and immediate postictal period, especially with generalized tonic-clonic seizures. Central apneas have been produced by electrical stimulation of mesial temporal structures. These respiratory disturbances suggest activation of the central autonomic network and may contribute to sudden unexpected death in epilepsy (SUDEP), the leading cause of epilepsy-related death in people with drug-resistant epilepsy. SUDEP typically occurs during sleep, and patients are more often found in a prone position and have a history of nocturnal seizures. Whether OSA contributes to SUDEP is unknown. Vagus nerve stimulation is a form of neuromodulation for drug-resistant focal epilepsy. When the device activates during sleep it causes reduction in airflow and respiratory effort, airflow obstruction, and oxygen desaturations, sometimes producing a clinical sleep apnea syndrome. The goal of this review is to discuss firmly established and recently recognized clinical, neurobiologic, electrophysiologic, and polysomnographic relationships between sleep-disordered breathing and epilepsy.
Asunto(s)
Epilepsia/complicaciones , Síndromes de la Apnea del Sueño/complicaciones , Muerte Súbita/prevención & control , Electroencefalografía , Epilepsia/fisiopatología , Epilepsia/terapia , Humanos , Polisomnografía , Síndromes de la Apnea del Sueño/fisiopatología , Síndromes de la Apnea del Sueño/terapiaRESUMEN
ABSTRACT: The most common sleep disorders that can result in injurious or violent behaviors include REM sleep behavioral disorder, sleepwalking, comorbid parasomnias, sleep-related dissociative disorder, and obstructive sleep apnea. Video polysomnography is usually indicated to evaluate recurring sleep-related injury in adults. Only one-third of patients with complex paroxysmal nocturnal events will have one of their habitual events on a single night of in-laboratory video polysomnography, most often those who have prominent, high-frequency motor features. We report evidence of sleep walking induced by sodium oxybate identified by steps recorded on a consumer wearable device coinciding with clinical history and evidence of injury.
Asunto(s)
Polisomnografía , Oxibato de Sodio/efectos adversos , Sonambulismo/inducido químicamente , Grabación en Video , Adulto , Trastornos de Somnolencia Excesiva/diagnóstico , Diseño de Equipo , Femenino , Humanos , Narcolepsia/diagnóstico , Parasomnias/inducido químicamente , Parasomnias/diagnóstico , Polisomnografía/instrumentación , Oxibato de Sodio/uso terapéutico , Sonambulismo/diagnósticoRESUMEN
BACKGROUND: The general principles in the administration of anesthetic drugs entail not only the suppression of seizure activity but also the achievement of electroencephalography burst suppression (BS). However, previous studies have reported conflicting results, possibly owing to the inclusion of various anesthetic agents, not all patients undergoing continuous electroencephalography (cEEG), and the inclusion of anoxic encephalopathy. This study aimed to analyze the effects of midazolam-induced BS on the occurrence outcomes in refractory status epilepticus patients. METHODS: Based on a prospective database of patients who had been diagnosed with status epilepticus via cEEG, multivariate Poisson regression modules were used to estimate the effect of midazolam-induced BS on breakthrough seizure, withdrawal seizure, intra-hospital complications, functional outcome at 3 months, and mortality. Modules were based on a pre-compiled directed acyclic graph (DAG). RESULTS: We included 51 non-anoxic encephalopathy, refractory status epilepticus patients. Burst suppression was achieved in 26 patients (51%); 25 patients (49%) had non-burst suppression on their cEEG. Breakthrough seizure was less often seen in the burst suppression group than in the non-burst suppression group. The incidence risk ratio [IRR] was 0.30 (95% confidence interval = 0.13-0.74). There was weak evidence of an association between BS and increased withdrawal seizure, but no association between BS and intra-hospital complications, mortality or functional outcomes was observed. CONCLUSION: This study provides evidence that BS is safe and associated with less breakthrough seizures. Additionally, it was not associated with an increased rate of intra-hospital complications or long-term outcomes.