Daytime behavior and sleep disturbance in 30 children with epilepsy, mean age 10.3 +/- 2.1 years, were evaluated by parent-rating questionnaires and child symptom self-report measures in a study at the University of Florida, Gainesville, FL. Complex partial seizures were diagnosed in 43% and generalized epilepsy in 57%. Sixty percent were seizure-free during the 56-day test period; 83% were on anticonvulsant medications; and 20% were also taking methylphenidate, except for 72 hours prior to the sleep study. Abnormal sleep architecture, breathing abnormalities, and excessive daytime sleepiness were frequently encountered, and 24 (80%) patients showed obstructive hypopneas or apneas with associated sleep disruption, as recorded by overnight polysomnograms. Parents’ reports indicated significant problems with inattention/hyperactivity in children with epilepsy. Behavioral problems were related to concomitant sleep disturbance and not to the severity or type of epilepsy. Correlation analyses of sleep and behavior problems indicated a significant relation between inattention/hyperactivity on the Connors’ Parent Rating Scale and REM latency (P<0.01) and periodic limb movement arousal (PLMA) index (P<0.05); between oppositional/externalizing behavior measure (Eyberg Child Behavior Inventory) and REM latency (P<0.05); and between the depression measure (Children’s Depression Inventory) and REM latency (P<0.05), PLMA index (P<0.01), and length of apnea (P<0.01). An initial sleep history in children with epilepsy may reveal the need for overnight polysomnography and may aid in the diagnosis and treatment of sleep disturbances and comorbid behavioral problems. [1]

COMMENT. The main findings in the above study are as follows: 1) children with epilepsy frequently suffer from sleep disorders and excessive daytime sleepiness; 2) they have a significantly increased prevalence of inattention/hyperactivity; and 3) associated behavior problems are not directly related to the severity of epilepsy but rather to the concomitant sleep disturbance.

Failure of sleep deprivation to increase tendency to epileptiform discharges in EEG.

The effects of sleep, standard sleep deprivation (SSD), partial sleep-deprivation (PSD)(awake for 2 hours later the night before the EEG), and no sleep deprivation (NSD) on the odds of an epileptiform abnormality in outpatient pediatric EEGs was studied at Cincinnati Children’s Hospital Medical Center, OH, during two-2-month periods. Of 820 EEGs recorded, sleep occurred in 22% of NSD, 44% of PSD, and 57% of SSD. Neither the presence of sleep nor the use of PSD or SSD protocols increased the odds of epileptiform EEGs. The authors conclude that sleep deprivation, posing a burden on both parent and child, should not be used routinely to increase the yield of pediatric EEGs [2]. The authors admit that sleep or sleep-deprived EEGs may provide useful information in certain epileptic syndromes (eg electrical status epilepticus during slow sleep), and the need for sleep may vary according to the clinical indications. Since these findings are contrary to general experience and opinion of many electroencephalographers, further studies are indicated.

Melatonin in wake-sleep disorders of mentally retarded children. Melatonin in bedtime doses of 3 mg up to 9 mg in 25 children and young adults, aged 3.6 to 26 years (mean 10.5 years), had a significant beneficial effect on sleep latency without altering the efficacy of concomitant antiepileptic drugs. [3]