![]() NREM parasomnias generally arise in childhood, they are less frequent and usually singular during the early part of a sleeping period. The American Academy of Sleep Medicine suggests RBD is diagnosed with polysomnography (PSG) as it can sometimes be dif cult to differentiate it from epilepsy on the history alone. Patients often recall their dreams, behaviour is often violent and episodes are repeated each night. Episodes occur late in the sleeping period where a higher concentration of REM sleep is seen. 14 Dream enactment occurs due to a lack of muscle atonia during REM sleep. REM parasomnia (REM behaviour disorder (RBD) is almost exclusively seen in elderly subjects with a male predominance, often associated with alpha synucleonopathies. Parasomnia episodes are seen in either rapid eye movement (REM) or non-REM (nREM) sleep. This review will begin with diagnostic issues, moving on to the effects of epilepsy and its treatments on sleep, the effects of sleep disorders on epilepsy and concludes with practical advice on assessment. Understanding this complex relationship can lead to better treatment outcomes for patients. 10 To add to this complexity, epilepsy treatments often have impact on sleep. Even when telemetry facilities are available, data can be difficult to interpret and EEG is not always diagnostic. Often diagnosis is difficult due to incomplete histories from sleep partners. 9 Many patients with epilepsy have seizures in sleep, some exclusively so. 8 Recognition of the comorbid sleep disorder and successful treatment can lead to significant improvements in seizure control. 4 Sleep disorders are up to three times as common in epilepsy 5 and can be a major contributor to refractory seizures, 6 poorer quality of life 7 and possibly SUDEP. 2 Sleep deprivation impairs this process 3 and epilepsy can upset this delicate balance. 1 Sleep has an important role in memory consolidation. ![]() Sleep and epilepsy are intimate bedfellows, having an impact on each other and adversely affecting quality of life and daytime performance. This article reviews this complicated but fascinating area addressing diagnostic issues, the effects of epilepsy and its treatments on sleep, the effects of sleep disorders on epilepsy concluding with some practical advice on assessment. Recognising this allows for a greater awareness of the importance of good quality sleep in epilepsy patients with potential benefits on seizure control and quality of life. “Although comparative studies are lacking, combining seems more effective for detecting major seizures because of the shortcomings of current audio detection.Epilepsy and sleep have a close association and a two way interaction. “The multimodal sensor might be of help in preventing ,” the researchers added. Limitations of this study include its small cohort size and the inclusion of only patients residing in long-term care facilities in the Netherlands, which may likely limit the ability to extrapolate the findings across the broader epilepsy population. Investigators identified seizures as being tonic-clonic, generalized tonic >30 seconds, hyperkinetic, or others (eg, clusters of short myoclonic/tonic seizures). Heart rate or movement detected nocturnal seizures via photoplethysmography or 3-dimensional accelerometry, respectively. A bracelet was worn by all participants on the upper arm during sleep for up to 2 to 3 months. ![]() Patients with an intellectual disability and a history of more than 1 major nocturnal seizure per month who resided in a long-term care facility at an epilepsy center in the Netherlands were enrolled (n=28). Measurement of heart rate and movement using a multimodal bracelet sensor may be effective for detecting nocturnal seizures of varying types in patients with epilepsy, according to results of a multicenter, prospective study published in Neurology. Patients with epilepsy wore a simple device on the upper arm during sleep for up to 2 to 3 months in this multicenter, prospective study.
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