Abstracts

Poor sleep exacerbates seizures. Obstructive Sleep Apnea (OSA) has been described to worsen seizure control and its treatment has been shown to improve seizures. Periodic Leg Movement of Sleep (PLMS) and Restless Leg Syndrome (RLS) have not been studied regarding seizure control. Improving sleep and treatment of these sleep disorders can benefit epilepsy patients.
Case series followed over 5-15 years by one author (BLE) and independent chart review by presenting author. Clinical history, physical examination, polysomnography (PSG) and electroencephalogram (EEG) results and treatment outcome are described.
An eighteen year-old right-handed woman with no family history of epilepsy (including Juvenile Myoclonic Epilepsy) presented with seizures consisting of staring episodes, slight head nod and eyelid fluttering lasting 4-6 seconds. Physical examination and MRI were normal. EEG showed 4-6 Hz spike-wave activity. Her PSG showed 77 unexplained arousals with spontaneous PLMS. She had a Total Arousal Index (TAI) of 18/hr. She had history of absence seizures at age 6 years, with remission thereafter until now. Three months before, she complained of excessive daytime sleepiness (EDS), increase leg movements at night and restlessness of legs in the daytime. Her seizures improved but not completely controlled on valproate, and there was massive weight gain. When Carbidopa/Levodopa was added, the seizures came under control and later remained so on Pramipexole.
A thirty two year-old right handed man presented with staring episodes lasting 20-30 seconds with a frequency of 1-2 a day. His physical examination and MRI were normal. One year before he had noticed increased fatigue, EDS and leg movements during sleep. EEG showed generalized spike-wave complexes, maximum bi-frontal. PSG demonstrated PLMS [Periodic Limb Movement Index (PLMI) of 10.9/hr], 60% of them associated with arousals. TAI was 15.6/hr. He had history of absence seizures starting at age 4. He was seizure free for 20 years before presentation. Valproic acid achieved some control, but the seizures disappeared completely with the addition of Carbidopa/Levodopa. Later, he remained seizure free with Pramipexole monotherapy.
A forty-one year-old woman had staring episodes with unresponsiveness and occasional Generalized Tonic Clonic seizures. Her EEG showed bursts of high voltage 3.5-4 Hz generalized spike-wave and polyspike-wave activity lasting 2-3 seconds without clinical correlation. Her PSG showed a PLMI of 21.4/hr, 69% associated with arousals. TAI was 13.1/hr. Her sleep improved after treatment with Carbidopa/Levodopa and later Pramepixole. Her seizure control improved [gt] 50%.
Sleep disorders other than sleep apnea can worsen seizure control in epilepsy patients. Furthermore, the relationship of RLS and/or PLMS to the reappearance of Childhood Absence seizures requires further investigation. Notably, leg movements tend to be genetically linked, as do some types of seizures, but either may delay emergence until late in life.