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The relationship between sleep and epilepsy: the effect on cognitive functioning in children

Pasquale Parisi¹, Oliviero Bruni, Maria Pia Villa

¹Child Neurology and Sleep Paediatric Disorders Centre, II Faculty of Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy. pasquale.parisi@uniroma1.it

Developmental Medicine and Child Neurology

|April 8, 2010

Insights

Epilepsy and poor sleep quality negatively impact cognitive function in children. Optimizing sleep and seizure control is crucial for better long-term outcomes.

Area of Science:

Pediatric Neurology
Sleep Medicine
Cognitive Neuroscience

Background:

Epilepsy in children is frequently associated with cognitive impairments.
Sleep disturbances are common in children with epilepsy and may exacerbate cognitive deficits.

Purpose of the Study:

To investigate the pathophysiological links between epilepsy, sleep (macro- and microstructure), sleep disorders, and cognitive functioning in children.
To clarify the interplay of sleep and epilepsy on cognitive outcomes in pediatric epilepsy.

Main Methods:

A comprehensive literature search was conducted using PubMed.
Studies involving children (0-18 years) or mixed populations with a significant pediatric cohort were included.
No language restrictions were applied.

Main Results:

Learning impairments in children with epilepsy are multifactorial, including etiology, electroencephalographic (EEG) discharges, and seizure characteristics.
EEG discharges can impact cognition and sleep independently of seizures.
Sleep deprivation and disruption negatively affect memory-learning processes and can influence EEG discharges and seizure activity.

Conclusions:

Improving long-term cognitive-behavioral prognosis in children with epilepsy necessitates both effective seizure control and enhanced sleep quality.
Antiepileptic drug selection should prioritize agents with minimal disruption to sleep architecture, particularly during non-rapid eye movement sleep.

Read full analysis

Abstract

Aim:

The purpose of this review was to examine the possible pathophysiological links between epilepsy, cognition, sleep macro- and microstructure, and sleep disorders to highlight the contributions and interactions of sleep and epilepsy on cognitive functioning in children with epilepsy.

Method:

PubMed was used as the medical database source. No language restriction was placed on the literature searches, and citations of relevant studies in the paediatric age range (0-18 y) were checked. Studies including a mixed population but with a high percentage of children were also considered.

Results:

The searches identified 223 studies. One reviewer scanned these to eliminate obviously irrelevant studies. Three reviewers scanned the remaining 128 studies and their relevant citations. The review showed that several factors could account for the learning impairment in children with epilepsy: aetiology, electroencephalographic (EEG) discharges, and persistence and circadian distribution of seizures, etc. EEG discharges may affect cognition and sleep, even in the absence of clinical or subclinical seizures. The sleep deprivation and/or sleep disruption affect the neurophysiological and neurochemical mechanisms important for the memory-learning process, but also influence the expression of EEG discharges and seizures. Learning and memory consolidation can take place over extended periods, and sleep has been demonstrated to play a fundamental role in these processes through neuroplastic remodelling of neural networks. Epilepsy and EEG paroxysms may affect sleep structure, interfering with these physiological functions.

Interpretation:

Improvement in the long-term cognitive-behavioural prognosis of children with epilepsy requires both good sleep quality and good seizure control. The antiepileptic drug of choice should be the one that interferes least with sleep structure and has the best effect on sleep architecture--thus normalizing sleep instability, especially during non-rapid eye movement sleep.

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