Other epilepsies have a tendency to occur upon awakening like Juvenile myoclonic epilepsy petite male epilepsy and epilepsy with grand mal seizures on awakening. Other sleep augmented epilepsies include benign focal epilepsy of childhood with centro-temporal spikes, Lennox Gastaut syndrome and frontal lobe epilepsies (either supplementary sensorimotor area (SSMA) or autosomal dominant nocturnal frontal lobe epilepsies).
The syndrome of continuous spike-wave discharges during sleep (CSWS) is a typical example of such epileptic conditions. The seizures epileptic activities increased during sleep were illustrated in a number of epileptic conditions and distinguished by uncommon clinical seizures but with significant cognitive impairment. Seizures originating from frontal lobe start during sleep more often than that arise from temporal lobe, a finding that is of clinical significance. Meanwhile, few seizures occur during stages of slow wave sleep (SWS) (stages III/IV) and fewer or none occur during stage of REM sleep. Most sleep-related seizures start during sleep stage II. The seizure activating role of NREM sleep has been attributed to increased neuronal synchronisation within thalamo-cortical projection neurons with robust activation of epileptic ictal and interictal activity. NREM sleep can enhance interictal epileptiform discharges in both partial and generalized seizures while REM sleep limits spread of epileptic discharges outside the area that started seizure activity and allows the localization of the primary epileptogenic area as seen in temporal lobe seizures. This is the reason that NREM may be considered as a natural “epileptogenic agent”. Many researches showed occurrence of generalized discharges and clinical seizures mainly in NREM sleep. These two neurophysiological conditions that distinguish sleep (NREM and REM) exert contradictory effects on interictal state and clinical conditions. Sleep consists of repetitive cycles each lasting about 90 min, advancing through non-rapid eye movement (NREM) stages to rapid eye movement (REM). Pavlova et al showed that frontal lobe seizures occurred more frequently between 12 midnight and 12 midday while temporal lobe seizures, occurred more often between 12 midday and 12 midnight. Nocturnal seizures most often occur in the early morning near the end of the sleep period (5 AM to 6 AM) and less frequently 1 to 2 h after sleep onset, while diurnal seizures frequently occur in the early morning and late afternoon. The ratio of the different epilepsy timing. However, presence of sleep fragmentation without a history of seizures or antiepileptic medication is suggesting that sleep disintegrity may be an intrinsic component of certain types of epilepsy. About 45% of patients with medically refractory epilepsy experienced excess daytime sleepiness. This means that epilepsy disturbs sleep and sleep deprivation may aggravate epilepsy due to the decrease in seizure threshold thus forming a vicious circle. This complex relationship and interaction between sleep and epilepsy was found to be interrelated. Over the last twenty years, there has been a vast growth in the awareness about the inherent relationship between sleep and epilepsy especially with the wide use of polysomnography and video electroencephalogram (EEG) monitoring. However, this interactive double-way effect shared between sleep and epilepsy was revealed only by the end of the 19 th century by Gower who was interested by the effect of sleep/awakens cycle on generalized tonic-clonic epilepsy. Description of episodes of epileptic seizures occurring during sleep was found in the extant writings of both Aristotle and Hippocrates. The possible association of epilepsy with sleep was known since long time. This is due to the strong link between the physiology of sleep state and the principal pathological mechanisms of the epileptic seizures. On the other hand sleep disorders are more prevalent in epileptic children and they are common associated epilepsy co-morbidities. One third of epileptic patients have seizures during the sleep. A seizure is a result of an increased electrical activity in the brain which causes sudden change in the behavior of the affected person. Epilepsy is a phenomenon of recurring seizures.
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