Nocturnal epilepsy causes7/28/2023 ![]() The cholinergic system and the mTOR pathway are the most relevant. The causative genes for SHE are multiple and encode for proteins involved in different molecular pathways. Non-specific clinical features distinguished different aetiologies even if SHE due to structural lesions usually manifests with early-onset drug-resistant seizures and showed a worse long-term prognosis. Multiple aetiologies (structural-genetic) are also possible. Recognized aetiologies of SHE are heterogeneous and include acquired injuries, genetic causes and structural anomalies such as focal cortical dysplasia. Distinguishing this condition from non-epileptic paroxysmal behaviour occurring physiologically or pathologically during sleep is often difficult and sometimes impossible on clinical grounds alone, even for experienced epileptologists and sleep physicians. This disorder, though uncommon, is of considerable interest to a broad spectrum of specialists, from child neurologists to neurosurgeons. SHE is a rare disease with an estimated minimum prevalence of 1.8/100,000 individuals and represent about 10% of drug-resistant surgical cases. Treating sleep disorders are a novel therapeutic opportunity that should not be missed, especially in people who fail other options.Sleep-related hypermotor epilepsy (SHE), formerly known as Nocturnal Frontal Lobe Epilepsy is a focal epilepsy characterized by seizures with complex hyperkinetic automatisms and/or asymmetric tonic/dystonic posturing occurring mostly during sleep. Thank you for bringing these exciting findings to light! Before we close, is there anything else you’d like to tell our readers?ĭon’t forget about sleep! 30-40% of people living with epilepsy have seizures despite optimal medical therapy. Short of that, more work needs to be done to extend these observations to children living with epilepsy, to confirm that beneficial effects extend to everyone living with epilepsy and not just those with refractory epilepsy, and to educate epilepsy caregivers who may not be aware of sleep disorders that impact people living with epilepsy. There has never been a prospective, multi-center trial to evaluate the effect of OSA treatment on seizures in people living with epilepsy. What future directions do you envision for research in this area? It is also important for physicians to ask their patients about these symptoms and to have a low index of suspicion for OSA. If they experience poor sleep quality, daytime fatigue or sleepiness, snoring, or breathing issues in sleep, they should talk with their health care provider. When should people ask their doctors about OSA? With treatment for OSA, people often experience improvement in symptoms they previously attributed to seizures or medications. This does not appear to differ by epilepsy type or degree of seizure control. We previously reported a prevalence of OSA in 40% of people living with epilepsy. Sleep disorders are highly common among people living with epilepsy and grossly underdiagnosed. It can negatively impact school or work performance. OSA is associated with stroke, heart disease, hypertension, diabetes, obesity, and sudden death. OSA occurs when breathing is interrupted during sleep. What would you like our readers to know about OSA? ![]() ![]() We found that people treated with PAP were more likely than those who were untreated to have a 50% decrease in seizures (63% vs 14%). Between these groups, we looked at who had a 50% reduction in seizure frequency over time. We divided people with OSA into those receiving PAP and those not receiving it. This was a retrospective study of adults living with epilepsy. Foldvary-Schaefer, please describe your study and highlight key findings? David Taplinger had a chance to ask her a few questions about this research, and here is what she had to say. ![]() Nancy Foldvary-Schaefer DO, MS, is a professor of medicine at the Cleveland Clinic, where she serves as director of the Sleep Disorders Center and has been on staff at the Epilepsy Center since 1995.Īt the American Epilepsy Society annual meeting last December, she presented exciting research on the relationship between seizure control and obstructive sleep apnea (OSA) in people living with epilepsy receiving positive airway pressure (PAP) therapy.
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