A Neurology Advisor report examines the link between insomnia, seizure control, and quality of life among patients with epilepsy.
A study published in Epilepsy Research investigated the link between insomnia, seizure control, and quality of life among 207 patients with epilepsy.5 Participants completed the Insomnia Severity Index (ISI) and the Quality of Life in Epilepsy Inventory (QOLIE-P-10), and the presence or absence of seizures pertaining to the preceding 4 was noted. Various data regarding demographics, sleep patterns, and mood were also recorded. Results showed that 43% of patients had clinically significant insomnia, and 51% had mild insomnia. Patients with continuing seizures had significantly worse ISI scores than those who were seizure free, and the variables associated with more severe insomnia included “(y)ounger age, shorter duration of epilepsy, use of sedative/hypnotics, medical and sleep comorbidities, delayed sleep timing and chronotype, excessive sleepiness, and depression,” the authors reported. Consistent with previous findings, more severe insomnia was also associated with worse QOL.
The study was not designed to determine cause and effect, but because it is known that seizures can be triggered by sleep deprivation or interruption, “we can infer that insomnia as a cause of insufficient sleep may worsen seizure control as well,” study co-author Mark Quigg, MD, MSc, a professor of neurology at the University of Virginia, told Neurology Advisor. “Furthermore, it may not be a one-way street, as other studies have demonstrated some effects of epileptic seizures or medications on the underlying sleep architecture,” he said.
Additionally, there are some types of epilepsy in which seizures occur only while the patient is asleep. “Some of these may even be confused for sleep disorders, namely nocturnal frontal lobe epilepsy, which can look like a parasomnia – such as sleep walking – when it is really a seizure,” said Liza H. Ashbrook, MD, a clinical fellow at the Stanford Sleep Medicine Center, who has a background in neurology and is now focusing on treatment of sleep disorders. “There are other epilepsy syndromes, such as benign epilepsy with centrotemporal spikes – previously called Rolandic epilepsy – and Panayiotopoulos syndrome, in which most seizures occur out of sleep,” she told Neurology Advisor. Alternately, some patients only experience seizures when they are deprived of sleep. It is well-known that patients with juvenile myoclonic epilepsy, for example, are very sensitive to sleep deprivation, Dr Ashbrook said.