Effect of sleep on epilepsy

There is an extremely intimate relationship between sleep and epilepsy. In this manuscript I will review the influence that sleep has on epilepsy. Sleep is a potent activator of interictal epileptiform discharges. Sharp waves are infrequent during wakefulness in benign focal epilepsy of childhood, but may occur in runs of several discharges per page in sleep. The interictal discharges become almost continuous in non-REM sleep in the syndrome of encephalopathy with electrical status epilepticus during slow wave sleep. In some patients with West syndrome a hypsarrhythmia pattern may only appear in sleep whereas in others there may be an increase in discharges in a semiperiodic fashion resulting in a burst-suppression like pattern. Seizures appear to have a very close relationship with sleep in certain epilepsy syndromes. In benign focal epilepsy of childhood the seizures occur almost exclusively in sleep, while supplementary sensorimototor area seizures tend to occur in clusters during sleep. Juvenile myoclonic epilepsy has a close relationship with the sleep-wake cycle with seizures tending to occur predominantly on awakening. I also discuss the role of sleep and sleep deprivation in the EEG evaluation of epilepsy.