Sleep and behavior disorders in 55 children with epilepsy (mean age 10 years; range 4-16 years) were compared with those in their non-epileptic siblings of the same ages and sex ratio and correlated with epilepsy-specific factors, in a study at Alberta Children’s Hospital, University of Calgary, Alberta, Canada. Sleep Behavior Questionnaires (SBQ), Child Behavior Checklists (CBCL), and Quality of Life (QOL) Scores were completed by parents and caregivers. Epilepsy was idiopathic generalized in 8 (15%), symptomatic generalized in 7 (13%), and focal in 40 (73%). Epileptiform discharges in the EEG were present in 51 patients, and in 62% of 39 with sleep records. Only 5 had nocturnal seizures. Seizures had been controlled for at least 3 months in 53%, and for 1 year in 24%. Treatment was monotherapy in 47%, >2 AEDs in 38%, and no AED in 15%.

Children with epilepsy have significantly longer sleep latency, increased parent-child interaction at night, increased sleep fragmentation, increased parasomnias, and increased daytime drowsiness compared to non-epileptic siblings. They also score significantly higher on behavior subscales (withdrawn, somatic complaints, social problems, thought and attention problems, and aggressive behavior) compared to controls. Higher total sleep disorder scores are correlated with higher scores on CBCL subscales (withdrawn behavior, somatic complaints, social problems, and attention deficits), and significantly lower total QOL scores. Refractory epilepsy (35%), mental retardation (53%), and remote symptomatic etiology are risk factors for greater sleep problems with epilepsy. [1]

COMMENT. Children with epilepsy have increased sleep problems compared to nonepileptic siblings, and sleep disorders are correlated with daytime behavior problems and a poorer quality of life. Sleep patterns are an important question in the evaluation of children with epilepsy.