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Updated: Jul 15, 2026
A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
A hypothesis for how non-REM sleep might promote seizures in partial epilepsies: a transcranial magnetic stimulation
Farid Salih1, Ramin Khatami, Saskia Steinheimer
1Neurologische Klinik und Poliklinik, and Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353 Berlin, Germany. Farid.Salih@charite.de
Purpose:
To investigate alterations of inhibitory and excitatory cortical circuits during non-rapid eye movement (NREM) sleep in drug-naive patients with partial epilepsies and sleep-bound seizures only.
Methods:
A paired-pulse TMS paradigm was used to test intracortical inhibition (ICI) and facilitation (ICF) in the hemisphere of the epileptic focus in three untreated patients with nonlesional, nongenetic frontal lobe epilepsy in NREM2 (three patients), NREM3/4 (one patient), and wakefulness (three patients).
Results:
All three patients exhibited a major decrease of ICI in NREM sleep as opposed to the physiological enhancement of ICI with the progression of NREM sleep.
Conclusions:
Decreased ICI might reflect a substrate for the association of epileptic processes with thalamocortical networks that propagate sleep. Thus our findings contribute to a hypothesis of how NREM sleep could promote seizures.
