How sleep disorders impact patients with epilepsy
Seizures are very sensitive to sleep patterns. Some people have their first and only seizures after an "all-nighter" at college or after not sleeping well for long periods. If you have epilepsy, lack of ‘good sleep’ makes most people more likely to have seizures. It can even increase the intensity and length of seizures.
In our Case of The Month article on an epilepsy patient treated with a vagal nerve stimulator we look at the relationship between sleep and epilepsy as well as how treatment with a vagal nerve stimulator affects the condition of the patient.The study offers an opportunity to review recognition of abnormal EEG activity, vagal nerve stimulator effects on sleep pattern and breathing during sleep, and the complex factors contributing to excessive daytime sleepiness in patients with neurological comorbidities and multiple medications.
What is vagus nerve stimulation?
Vagus nerve stimulation (VNS) is a technique used to treat epilepsy. It involves implanting a pacemaker-like device that generates pulses of electricity to stimulate the vagus nerve. The vagus nerve is one of the 12 cranial nerves, which conduct impulses between the brain and other parts of the brain and various body structures, mostly in the head and neck. The vagus nerve - the longest of the cranial nerves - also extends to organs in the chest and abdomen. It serves many organs and structures, including the larynx (voice box), lungs, heart and gastrointestinal tract.
How vagal nerve stimulation affects sleep and wakefulness
Vagal nerve stimulation has a variety of effects on sleep and wakefulness, which include: improved daytime alertness and sleep architectural changes, decreased REM sleep and increased awakenings, wake after sleep onset, and stage NREM 1 sleep.
Stimulation is also associated with decreases in airflow and effort coinciding with VNS activation. Please note that a sleep study in cases of suspected sleep apnea should be performed before implanting the VNS into the patient.
What our Case of The Month has to offer
The article chronicles an account with a patient who has intractable epilepsy treated with a vagal nerve stimulator. In a previous study she was diagnosed with obstructive sleep apnea and titrated with bi-level positive airway pressure. She returned to the sleep disorders center for re-evaluation due to complaints of excessive daytime sleepiness. The sleep specialist ordered a repeat study to evaluate the success of treatment.
The article offers 1 CEC for readers and is available for download here.
Want to learn more about the relationship between sleep and epilepsy? Check out our article here.