Severe Epileptic Encephalopathies

A number of severe epilepsies during early infancy may reflect a static condition of injury, or less commonly, metabolic/degenerative diseases. While the Lennox-Gastaut electroclinical syndrome usually occurs beyond infancy, some patients present as early as 1 year of age. The interictal EEG pattern consists of slow spike or wave discharges that are generalized, maximal over the frontal head regions. These slow spike or wave discharges can be further activated during drowsiness and NREM sleep.

Antiepileptic medications may also have an indirect effect on sleep organization. With antiepileptic medications, a decrease in the number of microarousals associated with seizures may ultimately improve both sleep organization and seizure control. Specific drugs such as phenobarbital may shorten sleep latency, increase the proportion of S2 sleep, decrease the proportion of REM sleep, and decrease the number and duration of arousals. Phenytoin alternatively may shorten sleep latency but has no effect on arousals or REM sleep percentage (Scher, 1996). Most studies, however, have centered on adults; few reports have addressed antiepileptic medication effects on sleep in young infants with seizures.

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