Nocturnal Sleep and Daytime Somnolence in Untreated Patients with Temporal Lobe Epilepsy: Changes After Treatment with Controlled‐Release Carbamazepine

Abstract

Summary:Purpose: To define sleep disturbances in patients with temporal lobe epilepsy (TLE) and explore the association between carbamazepine (CBZ) therapy, sleep, and daytime somnolence.Methods: We recorded nocturnal polysomnography and measured subjective and objective daytime somnolence in a group of newly diagnosed TLE patients, who had no evidence of anatomic brain lesion on neuroimaging and had never been treated before. Recordings were performed at baseline, after the initial administration of 400 mg CBZcontrolled release (CR) and after 1 month of treatment (400 mg twice daily b.i.d.). The findings were compared with those of a group of young healthy volunteers, both at baseline and after the first administration of CBZ. The chronic effect of CBZ-CR treatment was evaluated only in TLE patients.Results: At baseline, nocturnal sleep patterns of TLE patients did not show marked alterations when the influence of seizures, cerebral lesions, and drugs had been ruled out. In both the TLE and the control groups, initiation of CBZ therapy provoked a reduction and a fragmentation of rapid eye movement (REM) sleep and an increase in the number of sleep stage shifts. In the TLE group, these effects were almost completely reversed after 1 month of treatment, and no significant difference was noted between baseline condition and long-term follow-up. With regard to daytime sleepiness, initial administration of the drug caused an increase in objective sleepiness only in the control group. Subjective sleepiness was higher in the control group than in the TLE group but was not modified by the drug.Conclusions: We conclude that CBZ-CR has negative effects on REM sleep during initial administration but chronic treatment does not significantly modify nocturnal sleep or daytime somnolence.

Cognition and health-related quality of life in a well-defined subgroup of patients with partial epilepsy

“…The diminished speed of information processing we found has also been established by pharmacological studies and might be due to medication [32]. REM sleep deprivation for example, caused by CBZ, might have affected cognitive performance, although the magnitude of this effect compared with other epilepsy-related characteristics remains controversial [33]. In accordance with other pharmacological studies on CBZ [34],we did not find an association between CBZ dosage or years of CBZ intake and impaired cognitive performance in our study.…”

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

“…The type of the antiepileptic drug is also an important factor. For example, there are a few ones that promote stabilization and normalization of the sleep, such as phenytoin 25,26 , carbamazepine 20,25,27 , phenobarbital 25 and benzodiazepines 28,29 . However, there are some sedative antiepileptic drugs that may increase the sleepiness, such as clobazam, clonazepam and phenobarbital, which we defined as sedative AEDs.…”

Advances in the Management of Sleep Disorders in Juvenile Myoclonic Epilepsy

“…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.…”