Risk of seizures while awake in pure sleep epilepsies

Abstract

The clinical picture of pure sleep epilepsies is characterized by a preponderance of generalized tonic clonic seizures, low seizure frequency, and a good prognosis. The risk of occurrence of a seizure while awake is low, particularly among patients with rare seizures and good compliance with the therapy.

Awake seizures after pure sleep-related epilepsy: a systematic review and implications for driving law

“…The maximum estimated chance of seizure in the next year in Gibberd and Bateson's3 paper was 15% (95% CI (8.2 to 26.5%)) and for D'Alessandro et al's study 2004,22 5.7% (95% CI 3.0 to 10.4%).…”

“…D'Alessandro et al 22 published a multicentre study of 161 consecutive people with a new diagnosis of epilepsy and sleep-only seizures. Treatment was pragmatic with each centre allowed to treat as usual practice: 93% were given AEDs, and 78% achieved total seizure freedom at 2 years.…”

“…Multivariate analysis of D'Alessandro et al's data22 suggested that high initial seizure frequency and sudden AED withdrawal were associated with increased risk of awake seizures. Although intuitively correct, we must be cautious in relying on post hoc analysis of such small samples—for example, only two people had both risk factors.…”

“…Probability of new awake seizures, from Gibberd and Bateson 3. High transformation rates relate to low likelihood of treatment with antiepileptic drugs, and also patients were removed from study if they became seizure-free…”

“…Confidence intervals for these risks were calculated using the method of Wilson 24. The study design of two key papers7 22 prevented us from calculating these rates. We also identified: whether the patients developed a generalised or focal seizure disorder (and how this was ascertained); whether patients were taking AEDs at entry to the study and during the observation period; the response to medication; and the people with epilepsy excluded from the study.…”