ABSTRACT

Epilepsy leads changes in sleep structure. In patients with epilepsy, concomitant sleep disorder (sleep-disordered breathing, periodic limb movement disorder etc.) may increase the number of seizures. Juvenile Myoclonic Epilepsy (JME) composes 8-10% of hereditary idiopathic generalized epilepsy syndromes. Awakening suddenly and sleeplessness may trigger seizures. In general, sleep EEG is more abnormal than EEG recorded during wakefullness. While EEG changes are apparently activated during slow wave sleep, discharges have a tendency to diminish during R period. Cyclic altenating pattern (CAP) is characterized by periodic EEG activity of N sleep and transient electrocortical changes to be different from ground EEG activity and intervals last one minute. CAP is a periodic activity composed of A and B phases.

10 patients with JME followed for average of 4 years were examined by polysomnography (PSG). All patients were taking antiepileptic therapy and had no epileptic seizure for last three months. 10 individuals matched for ages considered as controls.

Median Epworth Sleepness Scale score was 3. Average time to fell asleep for patients with JME was 8.4 minutes, average total sleep time was 390 minutes, stage N1 9.8%, N2 41.5%, N3 21.9%, R 26.8%. No associated sleep disorder was observed. CAP results for patients with JME and controls were 39.9% and 26.6%, respectively.

Patients did not report any specific complaint for sleep disorder symptoms. Our study suggests that, when compared to control group, sleep EEG of patients with JME were more pathologic with the increment of arousals during sleep and provide ground to epileptic activity, disruption of sleep integrity and the possibility of associated sleep disorders. As a result, physicians should be careful for sleep disorders in epileptic patients who take medicine regularly, have no epileptic seizure and describe no sleep complaints.

Keywords: Epilepsy, Polysomnography, Cyclic Alternating Pattern (CAP)