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By CAFMI AI From Nature Reviews Neurology
Epilepsy and sleep disorders commonly coexist, creating a complex interplay that significantly affects clinical outcomes and quality of life for patients. Understanding these interactions is critical for clinicians managing epilepsy, especially given the high prevalence of concomitant sleep disturbances among this population. Recent research has revealed intricate bidirectional influences: epileptic activity can disrupt sleep architecture, while characteristics of sleep can modulate seizure susceptibility and severity. Such findings underscore the importance of holistic patient evaluation, incorporating assessment and management of sleep abnormalities as integral components of epilepsy care. This review synthesizes recent advances from clinical neurophysiology, neuroimaging, and molecular biology, providing a comprehensive view of how these two conditions influence each other at multiple levels. For clinicians, these insights reinforce the need to monitor sleep patterns routinely in epilepsy patients, addressing fragmented sleep, circadian disruptions, and specific changes in sleep oscillations that may worsen seizure control. Integrating these elements into clinical practice supports more individualized treatment approaches and the potential to improve patient outcomes by targeting sleep alongside traditional antiepileptic therapies.
The mechanistic basis for the interaction between epilepsy and sleep involves numerous neurobiological pathways, notably those regulating sleep macro- and microstructure and their influence on neuronal excitability. Disruptions in sleep architecture—such as fragmentation, reduced slow-wave sleep, or altered rapid eye movement (REM) phases—have been shown to affect the likelihood and characteristics of seizures. Thalamocortical networks, which are critical for sleep regulation, also appear to play a central role in seizure generation and propagation. Neuromodulatory imbalances, including alterations in neurotransmitters like gamma-aminobutyric acid (GABA) and glutamate, further compound this relationship by affecting neuronal excitability and synchronization. Clinically, this means that disturbances in specific sleep stages can serve as both markers and triggers of epileptic events. The review highlights how seizure activity reciprocally impacts sleep quality by causing fragmentation and altering normal sleep rhythms, thereby establishing a vicious cycle that can exacerbate both conditions. Understanding these mechanisms informs clinical strategies aimed at restoring healthy sleep patterns through interventions such as improved sleep hygiene, behavioral therapies, and novel pharmacological or device-based treatments designed to modulate neural circuits involved in both sleep and epilepsy.
These mechanistic insights have important practical implications for clinicians. Recognizing the intertwined nature of epilepsy and sleep disorders prompts the incorporation of comprehensive sleep assessments into routine epilepsy care. This can involve polysomnography or home sleep studies to identify specific disturbances such as sleep apnea or periodic limb movements, which may be amenable to targeted therapies and might substantially improve seizure control. Moreover, advancements in technology, including closed-loop neurostimulation devices and machine learning algorithms that use sleep-related biomarkers for seizure prediction, present promising avenues for personalized treatment. These tools enable real-time seizure control adjustments based on changes in sleep state, potentially reducing seizure frequency and improving patient quality of life. Clinicians should also consider counseling patients and caregivers about optimizing sleep hygiene and managing circadian rhythms, as these non-pharmacological interventions can bolster seizure management. Looking ahead, further research aimed at elucidating the molecular and network-level mechanisms connecting sleep and epilepsy will enhance therapeutic development. This integrated approach has potential to redefine clinical workflows in primary care and specialized neurology settings, emphasizing preventive strategies, early identification of comorbidities, and tailored interventions that collectively improve long-term outcomes for epilepsy patients.
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