The relation of serum melatonin levels to sleep patterns and effects on seizure severity were evaluated in 23 children with intractable epilepsy compared to 14 with controlled seizures, in a study at Ain Shams University, Cairo, Egypt. The children with intractable epilepsy had significantly higher scores in sleep walking, teeth grinding, and sleep apneas, compared to those with controlled epilepsy. Diurnal/nocturnal melatonin levels were not significantly different in patients with controlled seizures (10.79/28.7 pg/ml) and uncontrolled seizures (21.9/15.2 pg/ml). Diurnal levels in patients with controlled seizures were significantly lower than levels in a healthy control group (10.79 vs 25.95). Patients with intractable epilepsy received 1.5 mg regular release melatonin 30 min before bedtime for 3 months, in addition to their anticonvulsants that were not changed. An initial dose of 3 mg melatonin was changed to 1.5 mg because 2 patients had increased seizures. With oral melatonin, sleep disorders, including enuresis, sleep walking, sleep apnea, and Epworth sleepiness scores improved in patients with intractable epilepsy. Reduction in seizure severity was significant, but reduction in seizure frequency in 20 (87%) patients was not significant. Seizures increased in frequency in 3 (13%). EEGs became normal in 3 patients. Two patients had headache, skin rash, and abdominal pain. [1]

COMMENT. In this uncontrolled study of melatonin (1.5 mg) in children with refractory epilepsy, sleep continuity and some sleep-related disorders were significantly improved. Seizure severity, but not frequency, also showed significant improvement.