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The importance of sleep deprivation as a mechanism for activating interictal epileptiform paroxysms

P. Navas-Sánchez, L. Rodríguez-Santos, E. Bauzano-Poley, J.P. Lara, M.A. Barbancho [REV NEUROL 2016;62:289-295] PMID: 26988166 DOI: https://doi.org/10.33588/rn.6207.2015484

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Volumen 62 | Number 07 | Nº of views of the article 19.222 | Nº of PDF downloads 763 | Article publication date 01/04/2016

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ABSTRACT

INTRODUCTION Although sleep deprivation has been used for years in electroencephalography (EEG) as a method for activating interictal epileptiform discharges (IED) in patients with a strong suspicion of epilepsy, its sensitivity and specificity are still under discussion.

PATIENTS AND METHODS We conducted a descriptive retrospective study of paediatric patients who were referred to a neurophysiology clinic for epilepsy assessment. The results of the sleep-deprived EEG (SD-EEG) were compared with those of the wakefulness EEG (W-EEG) carried out in each patient in order to describe the performance of each method as a mechanism for activating IED.

RESULTS A total of 500 patients were analysed (830 SD-EEG and 1018 W-EEG). IED were detected in 44% of the W-EEG. SD-EEG increased the capacity of the test to detect IED by 35%. IED (not detected in the W-EEG) were detected in 25.1% of the SD-EEG in which spontaneous sleep was achieved. In the group of focal epilepsies, it was found that W-EEG detected IED in 60.1% versus the 79.12% displayed with SD-EEG. In generalised epilepsies this difference was more marked (27.2% and 77.2%, respectively). In patients in whom no IED were detected following an SD-EEG (23.7%) and the clinical suspicion of epilepsy was still high, nocturnal polysomnography was performed and interictal epileptiform activity was observed in 13.6%.

CONCLUSIONS SD-EEG increases the chances of recording IED by 35% with respect to W-EEG. Sleep deprivation is a method for activating epileptiform paroxysms, regardless of whether the EEG is performed while sleeping or not, although this effect is more pronounced in patients who do manage to sleep. KeywordsDiagnosis Electroencephalogram Epilepsy Interictal Sensitivity Sleep Sleep deprivation Wakefulness CategoriesEpilepsias y síndromes epilépticos Neuropsiquiatría Sueño

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Original

The importance of sleep deprivation as a mechanism for activating interictal epileptiform paroxysms