Circadian rhythm and profile in patients with juvenile myoclonic epilepsy and temporal lobe epilepsy

Abstract

Objective: This study intended to compare the circadian rhythm and circadian profile between patients with juvenile myoclonic epilepsy (JME) and patients with temporal lobe epilepsy (TLE). Method: We enrolled 16 patients with JME and 37 patients with TLE from the Outpatient Clinic of UNICAMP. We applied a questionnaire about sleep-wake cycle and circadian profile. Results: Fourteen (87%) out of 16 patients with JME, and 22 out of 37 (59%) patients with TLE reported that they would sleep after seizure (p , 0.05). Three (19%) patients with JME, and 17 (46%) reported to be in better state before 10:00 AM (p , 0.05). Conclusion: There is no clear distinct profile and circadian pattern in patients with JME in comparison to TLE patients. However, our data suggest that most JME patients do not feel in better shape early in the day.Keywords: juvenile myoclonic epilepsy, circadian rhythm, temporal lobe epilepsy, sleep. RESUMOObjetivo: Este estudo pretende comparar o ritmo circadiano e o perfil circadiano entre pacientes com epilepsia mioclônica juvenil (EMJ) e epilepsia de lobo temporal (ELT). Método: Nós entrevistamos 16 pacientes com EMJ e 37 com ELT do ambulatório da UNICAMP. Nós aplicamos um questionário sobre ciclo sono-vigília e perfil circadiano. Resultados: Quatorze (87%) de 16 pacientes com EMJ e 22 de 37 (59%) pacientes com ELT relataram que eles apresentam sonolência pós-crise (p , 0,05). Três (19%) pacientes com EMJ e 17 (46%) relataram um melhor estado geral antes das 10h00min (p , 0,05). Conclusão: Não há uma clara diferença de ritmo e de perfil circadiano entre pacientes com EMJ e ELT. No entanto, nossos dados sugerem que a maioria dos pacientes com EMJ não se sentem em sua melhor forma cedo pela manhã.Palavras-chave: epilepsia mioclônica juvenil, ritmo circadiano, epilepsia de lobo temporal, sono.

Advances in the Management of Sleep Disorders in Juvenile Myoclonic Epilepsy

“…So reinforcement of proper behavior and sleep hygiene should be encouraged by doctors and family members to help control of seizure in JME patients. (23) There are several key points of education and support of JME patients.…”

“…Lack of drive and endurance, unstable selfconcept, and rapidly changing affect and mood states are typical features of JME patients. (27) The social-cultural background of patients, rather than neurobiological factors, may be a reason for SDs (23) and for the depression and anxiety often described in JME. (28)(29)(30) Sh.Somayajula et al (31) studied PDs, psychosocial and socioprofessional integration, in 165 JME patients.…”

“…Succinimides (Phenytoin, Ethosuximide) (37,38) → normalization of the sleep in patients with insomnia (23) → a decrease in delta sleep and an increase in stage 1 nREMS (43) Barbiturates (Phenobarbital) (38) → sleepiness Benzodiazepines (Clonazepam, Clobazam) (41,42) → sleepiness → episodes of nocturnal apnoea (45) Iminostilbenes (Carbamazepine) (40) → anxiety…”

“…There are a few AEDs that promote stabilization and normalization of sleep, such as phenytoin, (23,37,38) carbamazepine, (23,39,40) and benzodiazepines. (23,41,42) On other hand, there are sedative AEDs that may increase sleepiness, such as clobazam, clonazepam and phenobarbital.…”

“…(23,41,42) On other hand, there are sedative AEDs that may increase sleepiness, such as clobazam, clonazepam and phenobarbital. Lamotrigine may cause dose-dependent insomnia.…”