Association of Interictal Epileptiform Discharges with Sleep and Anti-Epileptic Drugs

Abstract

Background: The presence of interictal epileptiform discharges (IEDs) in electroencephalogram (EEG) is diagnostic of epilepsy. Latent IEDs are activated during sleep. Anti-epileptic drugs (AEDs) improve sleep. AEDs, sleep, and IEDs may interact and affect epilepsy management. Purpose: To explore the occurrence of IEDs and its association with sleep and AED status in suspected patients of epilepsy. Methods: EEG records were collected of suspected patients of epilepsy who reported to the electrophysiology laboratory of a tertiary care hospital during 1 year. The anthropometric details, clinical presentations, and AED status of the patients were recorded from the EEG records. Patients were divided into 2 categories based on whether AEDs had been started prior to the EEG evaluation (category-I) or not (category-II). The occurrences of IEDs in EEG recordings in both categories were analyzed. Results: In 1 year, 138 patients were referred for diagnostic EEG evaluation. One-hundred-two patients fulfilled the inclusion criteria, of which 57 patients (53%) belonged to category-I and 45 patients (47%) belonged to category-II. Incidence of IEDs, suggestive of definite diagnosis of epilepsy in category-I was 88% and in category-II was 69%, and this difference was statistically significant (p = 0.02). Conclusion: The increased proportion of IEDs in category-I patients may be due to high clinical suspicion or compounding interaction of AEDs and sleep. More extensive studies are required to delineate the complex interaction of AEDs, sleep, and IEDs so that judicious yet prompt management of epilepsy can be carried out.

Effect of anti‐attention‐deficit hyperactivity disorder (ADHD) medication on clinical seizures and sleep EEG: A retrospective study of Japanese children with ADHD

“…They showed VPA superior to Phenobarbital in suppressing interictal epileptiform activity, including both focal and generalized epileptiform activity. Other report described AEDs improve sleep architecture, decrease sleep latency and nocturnal awakening which indirectly may modify interictal EEG abnormalities 33 . Spencer et al 34 confirmed a small but significant decrease in interictal discharges by AED withdrawal.…”

“…Other report described AEDs improve sleep architecture, decrease sleep latency and nocturnal awakening which indirectly may modify interictal EEG abnormalities. 33 Spencer et al 34 confirmed a small but significant decrease in interictal discharges by AED withdrawal. Another study reported some AEDs could abolish ictal epileptiform discharge in vitro, but that was unable to block interictal activity on EEG.…”

Bilateral dependence of sleep disorders and temporal lobe epilepsy – literature review

“…Another factor influencing the quality and quantity of sleep is anti-epileptic drugs (AEDs), and their effect differs depending on the patient [25,28,29]. What is certain, however, is that seizures affect the amount and quality of sleep, and sleep affects the frequency of seizures.…”

Sleep Disorders in Childhood Epileptic Disorders

“…Common IEDs are interictal spikes (<70 msec duration) and sharp waves epileptiform discharges (70-200 msec duration). It is commonly accepted that increasing frequency of IEDs are associated with increased risk of seizures in patients with epilepsy [4].…”