Effects of Antiepileptic Drugs on Sleep Structure in Patients with Frontal Lobe Epilepsy.
Abstract number :
1.098
Submission category :
Year :
2001
Submission ID :
123
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M. Ito, MD, Psychiatry and Neurology, Tenshi Hospital, Sapporo, Japan; Y. Takeda, MD, Psychiatry and Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; S. Sakakibara, MD, Psychiatry and Neurology, Hokkaido University Graduate Scho
RATIONALE: Several researchers have reported changes in sleep structures in patients with epilepsy. However, it is possible that those results had been influenced by the effects of antiepileptic drugs (AEDs). The relationship between AEDs and sleep is not yet fully understood. To evaluate the effects of AEDs on sleep, we conducted polysomnography (PSG) in patients with frontal lobe epilepsy (FLE) who had been treated with monotherapy using carbamazepine (CBZ) and valproate (VPA).
METHODS: Subjects consisted of three patients with FLE who had frequent nocturnal seizures. Their seizures consisted of tonic posturing of the limbs along with autonomic symptoms. These seizures occasionally evolved into generalized tonic-clonic seizure (GTCS). Interictal electroencephalography (EEG) showed bilateral frontal slow waves or spike and slow waves. These three patients were given monotherapy using CBZ and VPA. After the serum concentration of each drug reached therapeutic level, subjects underwent PSG for three consecutive nights. Sleep stages were scored according to Rechtschaffen and Kales' criteria. We also analyzed delta power (0.5-4Hz) using the maximum entropy method (MEM) for each 20-second epoch. The clinical features and sleep structures recorded were compared between CBZ and VPA.
RESULTS: GTCS did not occur with CBZ, but did occur with VPA. Stage shifts from stage 2 to stage 1 or stage W were much more frequent with CBZ than with VPA in all patients, as clinical or subclinical seizure discharges seemed to arise from stage 2, followed by body movement or awakening. In contrast, stage 3 and 4 decreased with VPA compared to with CBZ. Recorded delta power was low with VPA in all patients.
CONCLUSIONS: We found the effects of each AED to differ on structure of seizure and sleep. CBZ suppressed GTCS, while VPA did not. However, stage shifts due to seizure discharges showed a larger decrease with VPA than with CBZ. These findings suggest that CBZ may suppress the generalization of epileptic discharge and that VPA may suppress the occurrence of epileptic discharge. Slow waves decreased with VPA compared to with CBZ. VPA may exert an influence on slow wave sleep.