Epilepsy and Electroencephalography

CME


Preface


Sleep-Related Epilepsy and Electroencephalography



Madeleine M. Grigg-Damberger, MD


Department of Neurology, University of New Mexico School of Medicine, MSC10 5620, One University of NM, Albuquerque, NM 87131-0001, USA


E-mail address: mgriggd@salud.unm.edu


E-mail address: foldvan@ccf.org



Nancy Foldvary-Schaefer, DO, MS

,

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Epilepsy Center, Cleveland Clinic Neurological Institute, 9500 Euclid Avenue, FA 20, Cleveland, OH 44195, USA


E-mail address: mgriggd@salud.unm.edu


E-mail address: foldvan@ccf.org


Relationships between sleep and epilepsy have been described since antiquity. In recent decades, polysomnography (PSG) and video electroencephalography (EEG) have extended early clinical observations. In turn, heightened awareness of these complex relationships has increased the role of the sleep clinician and sleep laboratory in the evaluation and treatment of patients with epilepsy and unexplained events in sleep.


In this volume of Sleep Medicine Clinics, experts in the fields of epileptology, sleep medicine, and EEG provide an overview of the basic concepts of EEG and seizure/epilepsy classification and highlight specific sleep-related epilepsies and aspects of the field that are relatively well established or rapidly evolving.


We begin with the nuts and bolts of EEG by Dr Epstein, who discusses the origin of the scalp EEG and illustrates common electrode artifacts, filters, sampling rates, and derivations and montages for the polysomnographer. Drs Raju and Radtke and Drs Vendrame and Kothare discuss the ontogeny of normal EEG, benign variants commonly mistaken for epileptic activity, and nonepileptiform EEG abnormalities and their significance in polysomnographic recordings. We discuss the indications for combining EEG and PSG to evaluate unexplained nocturnal events and assess patients with neurological disorders in the sleep laboratory. We illustrate various ictal and interical EEG abnormalities and EEG localization rules and offer strategies to optimize the yield of EEG and video recordings in the sleep laboratory. Recognizing seizures and epilepsies in the sleep clinic and laboratory requires knowledge of seizure semiology, its implications on epilepsy localization, and the history of epilepsy classification. In the last of these introductory articles, Drs Vendrame and Loddenkemper review the approach to evaluating patients with seizures and provide the framework for classifying epilepsy using the clinical history, neuroimaging, and electrophysiological testing.


Sleep is an important modulator of interictal EEG abnormalities and seizures. Sleep deprivation and sleep disorders activate some types of epilepsy. Furthermore, seizures in certain epilepsies are closely linked with the sleep/wake cycle, underscoring the importance of routinely assessing sleep/wake complaints in patients with epilepsy. We then review the prevalence of sleep complaints and primary sleep disorders in people with epilepsy and the diagnostic yield of sleep and sleep deprivation on the EEG. Drs Hofstra-van Oostveen and de Weerd discuss the impact of circadian rhythms on seizure occurrence in different epilepsy syndromes.


Next, several epileptic disorders characterized by seizures appearing predominately or exclusively in sleep are highlighted. Dr Provini and colleagues discuss nocturnal frontal lobe epilepsies (NFLE) and the diagnostic challenges these syndromes pose to sleep specialists and epileptologists alike. The differentiation between NFLE and disorders of arousal and other paroxysmal nocturnal events is then reviewed by Dr Derry. Dr Rubboli and colleagues discuss the role of central pattern generators (CPGs), neural circuits producing stereotyped motor activities essential for survival, and the hypothesis that activation of CPGs produces similar motor behaviors in parasomnias and epileptic seizures. Dr Bruni and colleagues review rolandic and occipital benign epilepsies of childhood, the most common epileptic disorders in childhood and strictly linked to sleep. Drs Liukkonen and Grigg-Damberger describe electrographic status epilepticus in slow-wave sleep, an EEG pattern characterized by continuous spike-wave discharges during NREM sleep, typically associated with seizures, cognitive regression, and motor impairments. Finally, Dr Grigg-Damberger discusses sudden unexpected death in epilepsy (SUDEP), the most common cause of death directly attributable to epilepsy and a research priority in the scientific community. The roles of sleep, respiration, impaired autonomic functioning, and nocturnal seizures in SUDEP are reviewed.


We hope you enjoy this volume of Sleep Medicine Clinics on sleep-related epilepsy and EEG and find it a useful resource when evaluating patients in your sleep clinic and laboratory. These reviews illustrate a multitude of opportunities available to sleep and epilepsy investigators for clinical and basic research in this exciting, rapidly evolving field.


Related posts:

  1. to Seizures, Epilepsies, and Epilepsy Syndromes
  2. Seizures from Other Paroxysmal Nocturnal Events in Young and Older Adults
  3. Unexpected Death in Epilepsy: What Does Sleep Have to Do With It?
  4. Electroencephalography Across the Lifespan

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May 28, 2017 | Posted by in RESPIRATORY | Comments Off on Epilepsy and Electroencephalography

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