It is a double relationship that links sleep to epilepsy. On the one hand, sleeping well and continuously protects against epileptic seizures, on the one hand it is in sleep that the disease can experience its most flourishing moment during the 24 hours, where epileptic seizures are more likely to occur.
A game of balance, which is important to pay attention to, because sleep, but more generally the circadian rhythms, weigh on the disease, to the point of considering them an integral part of therapy. He is convinced of it Claudio Liguorispecialist in Neurophysiopathology Outpatient Sleep Disorders, Epilepsy, Parkinson’s Disease UOC Neurology Polyclinic Tor Vergata – Rome.
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The different types of attacks
Liguori in Geneva, where the ILAE (International League Against Epilepsy) European epilepsy congress was held, illustrated the promises of studying the sleep-wake rhythm as a tool to improve the treatment of epileptic seizures. Starting precisely from the double thread that binds sleep to epilepsy: “Sleep changes cyclically throughout the night, with an alternation of REM sleep and non-REM sleep, with internal oscillations in turn. It is a highly dynamic process. and this makes it easier for epileptic alterations to occur. This is true both for seizures, there are some forms of epilepsy that occur mainly in the course of sleep, and for intercritical manifestations, or anomalies that do not become seizures but are indicative of the form of pathology “, he explains.
Good sleep quality protects against seizures
But on the other hand, a sleep without awakening, with a good amount of REM sleep, protects against seizures, continues Liguori: “An inadequately rested brain is a brain where it is easier for discharges to occur, due to a matter of cortical excitability. which increases in case of sleep deprivation. And since epilepsy is a negative phenomenon of cortical excitability, the more there is cortical excitability, the more there is the risk of having an epileptic manifestation “.
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What are the best rhythms
The ideal would be to advocate a well-balanced sleep-wake rhythm alternation, which includes physical and mental activities during the day, avoiding falling asleep and resting too often, so as to relegate good rest to the night. Sleep, but more correctly the sleep-wake rhythm, must be studied because it can become part of the therapy, it can optimize it: “We have to move from watching only a slice of the 24 hours to watch all 24 hours, also studying the wakefulness that precedes sleep. All this with a view to optimizing therapy, to find and place drugs at the right times, and to reconcile the benefits of the drug with good sleep and adequate wakefulness – resumes Liguori – Drugs often tend to make you drowsy, so if you exceed with daytime therapy there is a risk that the patient is less active and less lucid because more tired and drowsy from drugs “.
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The importance of sleep hygiene
The sleep-wake rhythm is often altered, and not only in relation to the social habits that lead us to stay up, study, work late, and sleep less: “Even in patients who are well, altered melatonin secretions or alterations in the sleep-wake rhythm, to the point of making us believe that this is an intrinsic characteristic of the disease – says Liguori – this should push us even more to think not only of pharmacological treatments against epilepsy, but also of modulations of the sleep-wake rhythm , with good sleep hygiene, cognitive-behavioral therapy approaches, without necessarily intervening with different drugs or pharmacological interventions, namely chronotherapy, that is, taking into account the characteristics of the patient’s circadian rhythm “.
A doctor’s guide on what to do
There is still little talk of all this in clinical practice, also sometimes due to the lack of skills in both epilepsy and sleep medicine in the neurologist who follows the patient. Which, in addition to prescribing drugs, could therefore provide indications of sleep psychoeducation, starting from the knowledge of his sleep-wake rhythm, aiming to improve vigilance during the day and sleep at night, correcting the patient’s activities.
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“In addition to the general rules of going to sleep at a regular time, maintaining 7/8 hours of sleep, trying not to take exciting substances, we should aim to make the patient active during the day, with sports activities perhaps relegated to the morning, observing a correct exposure to light, starting with not wearing sunglasses in the morning because they do not help to decrease melatonin levels and make us wake up later. Sometimes the importance of these basic indications is not considered enough while it can do difference, because even a single night of sleep deprivation is enough to trigger the recovery of an epileptic seizure despite a prolonged period of well-being “, concludes Liguori.
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