Sleep and epilepsy: A snapshot of knowledge and future research lines

Sleep and epilepsy have a reciprocal relationship, and have been recognized as bedfellows since antiquity. However, research on this topic has made a big step forward only in recent years. In this narrative review we summarize the most stimulating discoveries and insights reached by the “European school.” In particular, different aspects concerning the sleep–epilepsy interactions are analysed: (a) the effects of sleep on epilepsy; (b) the effects of epilepsy on sleep structure; (c) the relationship between epilepsy, sleep and epileptogenesis; (d) the impact of epileptic activity during sleep on cognition; (e) the relationship between epilepsy and the circadian rhythm; (f) the history and features of sleep hypermotor epilepsy and its differential diagnosis; (g) the relationship between epilepsy and sleep disorders

Evaluation of hypersomnolence: From symptoms to diagnosis, a multidimensional approach

Hypersomnolence is a major public health issue given its high frequency, its impact on academic/occupational functioning and on accidentology, as well as its heavy socio-economic burden. The positive and aetiological diagnosis is crucial, as it determines the therapeutic strategy. It must consider the following aspects: i) hypersomnolence is a complex concept referring to symptoms as varied as excessive daytime sleepiness, excessive need for sleep, sleep inertia, or drowsiness, all of which warrant specific dedicated investigations; ii) the boundary between physiological and abnormal hypersomnolence is blurred, since most symptoms can be encountered in the general population to varying degrees without being considered as pathological, meaning that their severity, frequency, context of occurrence and related impairment need to be carefully assessed; iii) investigation of hypersomnolence relies on scales/questionnaires as well as behavioural and neurophysiological tests, which measure one or more dimensions, keeping in mind the possible discrepancy between objective and subjective assessment; iv) aetiological reasoning is driven by knowledge of the main sleep regulation mechanisms, epidemiology, and associated symptoms. The need to assess hypersomnolence is growing, both for its management, and for assessing the efficacy of treatments. The landscape of tools available for investigating hypersomnolence is constantly evolving, in parallel with research into sleep physiology and technical advances. These investigations face the challenges of reconciling subjective perception and objective data, making tools accessible to as many people as possible and predicting the risk of accidents

Nocturnal agitation: From sleep state dissociation to sleep-related dissociative state

Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate identification of its etiology is critical for appropriate therapeutic intervention. In children and young adults, distinguishing between non-rapid eye movement (NREM) sleep parasomnias and psychogenic non-parasomniac manifestations, a condition known as sleep-related dissociative disorder (SRDD), can be challenging. This review aims to summarize current clinical, neurophysiological, and epidemiological knowledge on NREM parasomnia and SRDD, and to present the pathophysiological hypotheses underlying these nocturnal manifestations. Sleepwalking, sleep terror and confusional arousals are the three main presentations of NREM parasomnias and share common clinical characteristics. Parasomniac episodes generally occur 30 minutes to three hours after sleep-onset, they are usually short, lasting no more than few minutes and involve non-stereotyped, clumsy behaviors with frequent amnesia. The prevalence of NREM parasomnia decreases from 15–30% in children to 2–4% in adults. Parasomniac episodes are incomplete awakening from the deepest NREM sleep and are characterized by a dissociated brain activity, with a wake-like activation in motor and limbic structures and a preserved sleep in the fronto-parietal regions. SRDD is a less known condition characterized by dramatic, often very long episodes with frequent aggressive and potentially dangerous behaviors. SRDD episodes frequently occur in quiet wakefulness before falling asleep. These dissociative manifestations are frequently observed in the context of psychological trauma. The pathophysiology of SRDD is poorly understood but could involve transient changes in brain connectivity due to labile sleep-wake boundaries in predisposed individuals. We hypothesize that SRDD and NREM parasomnia are forms of sleep-related dissociative states favored by a sleep-wake state dissociation during sleep-onset and awakening process, respectively

Narcolepsie et hypersomnie idiopathique : évaluation du besoin d’information des pharmaciens d’officine et de la pertinence de l’usage d’une messagerie sécurisée pour assurer le lien ville-hôpital

International audienceIntroductionAfin d’assurer une dispensation de qualité avec les conseils adaptés, il est important que les pharmaciens disposent de toutes les informations sur la pathologie concernée. Cette étude a pour objectif d’évaluer les connaissances du pharmacien d’officine sur la narcolepsie et l’hypersomnie idiopathique et de mettre en place via la messagerie sécurisée, l’envoi de fiches d’informations pour les pharmaciens d’officines et les patients.MéthodesUn questionnaire portant sur l’évaluation des connaissances des pharmaciens d’officines sur ces pathologies et leurs traitements, a été envoyé à 5117 pharmaciens d’officines. Par ailleurs, des fiches d’informations sur la prise en charge de la narcolepsie et de l’hypersomnie idiopathique ont été envoyées par messagerie sécurisée aux pharmaciens d’officines (n = 103) de patients suivis dans les centres lyonnais de référence pédiatrique et de compétence adulte pour la narcolepsie et l’hypersomnie idiopathique.RésultatsCent vingt-trois pharmaciens ont répondu au questionnaire d’évaluation des connaissances. La note moyenne d’autoévaluation des connaissances des pharmaciens était de 0,96/3. Au total, 99,2 % des répondants ont déclaré avoir besoin de plus d’information sur ces pathologies. Un retour très positif a été reçu de la part des pharmaciens d’officines ayant bénéficié d’un envoi d’information par messagerie sécurisée MonSisra.DiscussionCette étude a montré qu’il existe un besoin d’information des pharmaciens d’officines pour la prise en charge des patients atteints de narcolepsie ou d’hypersomnie idiopathique. Le transfert d’informations par messagerie sécurisée pourrait favoriser le lien ville/hôpital dans ce contexte et permettre d’optimiser la prise en charge des patients atteints de maladies rares tout au long de leur parcours

IV steroids during long episodes of Kleine-Levin syndrome.

To retrospectively compare the benefits (episode cessation) and risks of IV methylprednisolone (IV-MP) vs abstention during prolonged Kleine-Levin syndrome (KLS) episodes. A total of 26 patients with KLS received 1 g/d IV-MP for 3 days during 1 to 6 episodes each (totaling 43 IV-MP sessions). The change of episode duration with IV-MP (vs previous episode duration) was compared with the change duration between 2 consecutive episodes in 48 untreated patients matched for age, sex, age at KLS onset, number of episodes, and disease duration (more treated than untreated patients had long episodes). Eleven patients (42.3%) had an episode that was at least 1 week shorter than the preceding one when they received IV-MP therapy, whereas shorter episodes were significantly less frequent (10.4%) in the untreated group. This benefit was more marked (65.5% responders, 12 fewer days in an episode vs 0 days in the untreated patients) when IV-MP was infused before the 10th day of the episode. Mild, transient adverse effects (insomnia, muscle pain, nervousness/restlessness, but no manic switching) were reported by 61.3% of patients. No specific responder profile was identified. In this open-labeled, naturalistic study, early IV-MP (following the protocol for multiple sclerosis relapses) had a good benefit/risk ratio during KLS episodes in patients with long episodes (with half of the patients having an early cessation of episodes). This study provides Class IV evidence that for patients with long episodes of KLS, IV steroids decrease the duration of KLS episodes