Chronotype variability in epilepsy and clinical significance: scoping review.

PURPOSE: Chronotype, which captures a person's daily preferences for activity and sleep, is still a poorly researched area in epilepsy research. Finding common chronotype characteristics in people with epilepsy (PWE) and explaining possible effects on seizure management are the main goals. METHODS: Eleven large-scale investigations from 2010 to 2023 were examined in this scoping review. These studies included 1.167 PWE and 4.657 control subjects. RESULTS: PWE had intermediate chronotypes more often than not. Adult patients were more morning-oriented overall, while pediatric cohorts were variable. Relationships between chronotype and seizure control were limited since only two studies in adults reported this and those results conflicted. An evening-type chronotype was found to be more common in generalized epilepsy than focal. The relationship of chronotype and specific antiseizure medication (ASM) therapy was not investigated. CONCLUSIONS: The majority of PWE displayed an intermediate chronotype, but analyses based on age showed more nuanced trends, with children displaying variable patterns, adults generally tending toward morningness, and generalized epilepsy being associated with eveningness. This review underscores the importance of more research on the complex connections between epilepsy outcomes and chronotype. It emphasizes the need to study larger samples of PWE with carefully documented seizure control and ASM therapy, including dose and timing of administration to better understand the role of chronotype on epilepsy outcomes.

Periodic limb movements during sleep vs seizures and epileptiform discharges: some supposedly shared pathomechanisms / Movimentos periódicos dos membros durante o sono vs crises e descargas epileptiformes: alguns patomecanismos supostamente compartilhados

This is a narrative review that assesses some possible underlying abnormal mechanisms shared between periodic limb movements during sleep (PLMS) and interictal epileptiform discharges (IEDs) or epileptic seizures. The underlying abnormal mechanisms of PLMS are not clearly defined, but the hypotheses raised include a pure motor mechanism originating in the brainstem, spinal cord or a cortico-subcortical interaction, influenced by predisposing factors, through neural networks. PLMS rhythmicity appears to be closely linked to sleep microarchitecture, and also to cortical arousals, as with some types of epilepsy, which involve both the underlying sleep rhythms and their intrinsic functions as well as the so-called central pattern generators that produce rhythmic motor patterns. However, the relationship between PLMS and epilepsy has not yet been fully clarified. Rhythmicity and sleep fragmentation appear to be common denominators between them, at least more closely in sleep-related hypermotor epilepsy. To some extent, the electroencephalographic changes of PLMS would express an epiphenomenon of the involvement of some underlying brain networks common to epileptic seizures and IEDs.

Esta é uma revisão narrativa que avalia alguns possíveis mecanismos anormais subjacentes compartilhados entre os movimentos periódicos dos membros durante o sono (MPMS) e as descargas epileptiformes interictais (DEIs) ou crises epilépticas. Os mecanismos anormais subjacentes dos MPMS não estão claramente definidos, mas as hipóteses levantadas incluem mecanismo motor puro originado no tronco cerebral, medula espinhal ou uma interação córtico-subcortical, por influência de fatores predisponentes, através das redes neurais. A ritmicidade dos MPMS aparece estar intimamente ligada à microarquitetura do sono, e também aos despertares corticais, como acontece com alguns tipos de epilepsia, o que envolve tanto os ritmos subjacentes do sono e suas funções intrínsecas quanto os chamados geradores de padrões centrais que produzem padrões motores rítmicos. No entanto, a relação entre PLMS e epilepsia ainda não foi totalmente esclarecida. Ritmicidade e fragmentação do sono parecem ser denominadores comuns entre eles, pelo menos mais intimamente na epilepsia hipermotora relacionada ao sono. Em certa medida, as alterações eletroencefalográficas de PLMS expressariam um epifenômeno do envolvimento de algumas redes cerebrais subjacentes comuns a crises epilépticas e IEDs.

Parkinson's disease and periodic limb movement in sleep / Doença de Parkinson e movimentos periódicos dos membros durante o sono

Parkinson's disease is a neurodegenerative disease understood as a complex syndrome with motor and non-motor symptoms, including sleep-related conditions, such as periodic limb movements in sleep (PLMS). This paper presents issues regarding Parkinson's disease, motor and non-motor symptoms, sleep physiology, and PLMS. In conclusion, both conditions seem to be correlated through impairment of the dopaminergic system.

A doença de Parkinson é uma doença neurodegenerativa entendida como uma síndrome complexa com sintomas motores e não motores, incluindo condições relacionadas ao sono, como movimentos periódicos dos membros durante o sono (MPMS). Este artigo apresenta questões relacionadas à doença de Parkinson, sintomas motores e não motores, fisiologia do sono e MPMS. Em conclusão, ambas as condições parecem estar correlacionadas por comprometimento do sistema dopaminérgico.

Prevalence of periodic limb movement in sleep in people with epilepsy: A semi-structured literature review.

OBJECTIVES: Epilepsy is a prevalent health problem worldwide in all ages, and it is essential to identify disease markers for diagnosis and treatment. Periodic limb movements in sleep (PLMS) are a common finding in polysomnography (PSG). Still, its clinical relevance in people with epilepsy (PWE) is unknown. The aim of this review was to compare PLMS frequency in PWE and controls. METHODS: A semi-structured literature review was conducted using PubMed in search of relevant studies in English on August 23, 2019, with the search terms "sleep," "epilepsy," or "seizure," and "polysomnography" in the title and/or abstract. The research was complemented with citation analysis and manual search using Google Scholar. Studies involved PWE and comparative controls using PSG with reported PLMS index (PLMI). RESULTS: Seven studies were identified. Only two showed a statistically significant difference in PLMI between cases and controls, and in another study, cases had uncontrolled seizures. In general, studies did not adjust for potential confounders including demographics, apnea-hypopnea index, or medication use. CONCLUSIONS: We found few studies exploring the prevalence of PLMS in PWE. In the majority, PLMI did not differ from controls. Further studies are warranted given the prevalence of sleep disturbances in epilepsy.

Síndrome de flutter ocular e ataxia de tronco pós-infecciosa / The post-infectious ocular flutter syndrome and truncal ataxia

OBJETIVO: Descrever um quadro clínico subagudo pós-infeccioso caracterizado por ataxia de tronco e flutter ocular. RELATO DE CASO: Um homem de 37 anos previamente hígido, pouco após um quadro sistêmico inespecífico que se resolveu espontaneamente, deu início a movimentos involuntários hipercinéticos dos olhos, da cabeça e desequilíbrio importante. Os sintomas evoluíram em poucos dias. Ao exame, apresentava ataxia de tronco e presença de flutter ocular. O líquor mostrou pleocitose discreta. Ressonância magnética (RM) de crânio e exames laboratoriais normais. Houve melhora espontânea e total dos sintomas em cerca de três semanas. CONCLUSÃO: A síndrome de flutter ocular e ataxia de tronco é rara e é destacado a benignidade do quadro.

OBJECTIVE: To describe a post-infectious subacute clinical picture characterized by truncal ataxia and ocular flutter. CASE REPORT: A healthy 37-year-old man, a few days after spontaneously resolved nonspecific systemic disease, initiated involuntary hyperkinetic movements of the eyes, head, and major imbalance. The symptoms progressed within a few days. He presented ataxia of the trunk and presence of ocular flutter. CSF showed pleocytosis. Magnetic resonance of the skull and laboratory tests were normal. There was spontaneous and total improvement of symptoms in about three weeks. CONCLUSION: The ocular flutter syndrome and truncal ataxia is rare and the benignity of the condition is highlighted.

Sleep architecture in adults with epilepsy: a systematic review.

OBJECTIVES: To assess whether sleep architecture differs in subgroups of adults with epilepsy or in adults with epilepsy compared to control populations. METHODS: We completed a systematic review of papers published in two databases up to May 2018, with adults with epilepsy who have undergone either two consecutive nights of in-laboratory polysomnography (PSG) or one night of ambulatory PSG. Our review followed the PRISMA statements and guidelines and the protocol was registered in the PROSPERO platform prior to initiation of the review process (record CRD42018084009). RESULTS: Five studies out of 872 fulfilled our eligibility criteria. Only one study reported a significant difference in any sleep architecture parameter in group comparisons. Crespel et al., found that wake after sleep onset (WASO) time in minutes was higher in patients with refractory temporal lobe epilepsy when compared to refractory frontal lobe epilepsy (78.2 ± 5.3 vs. 28.1 ± 2.2; p < 0.01) and healthy controls (78.2 ± 5.3 vs. 27.9 ± 18.9; p < 0.007). CONCLUSIONS: Only a few studies objectively assessed sleep in adults with epilepsy while controlling for key factors that influence sleep. However, even those reports are heterogeneous in regards to methodology and population characteristics. Further studies are required to access the extent of sleep architectural abnormalities in adults with epilepsy.