The impact of antiseizure medications on polysomnographic parameters: a systematic review and meta-analysis.

BACKGROUND: Oral antiseizure medications (ASMs) are first-line treatments for patients with epilepsy. However, ASMs may alter sleep architecture, adversely affecting patient outcomes. The meta-analysis aimed to elucidate the effect of ASMs on sleep architecture. METHODS: PubMed, Embase, and Cochrane Central database (up to Febrary 2021) were searched for randomized control trials (RCT) with effects of ASMs on polysomnography parameters. A meta-analysis using a random-effects model was performed. We did not set limitation to the participants with underlying diagnosis of epilepsy. RESULTS: Eighteen randomized-controlled trials fulfilled the eligibility criteria. The effects of five main groups of ASMs (sodium channel blockers, calcium channel blockers, GABA enhancers, synaptic vesicle glycoprotein 2A [SV2A] ligand, and broad-spetrum ASMs) on slow-wave sleep (SWS), rapid eye movement (REM) sleep, and sleep efficiency (SE) were analyzed. Compared with placebo, calcium channel blockers and GABA enhancers significantly increased SWS. GABA enhancers also decreased REM sleep percentage, whereas calcium channel blockers significantly increased SE. Sodium channel blockers, SV2A ligand and broad-spectrum ASMs did not affect SWS, REM sleep, or SE. The subgroup analysis revealed that gabapentin, pregabalin, and tiagabine increased the percentage of SWS. Tiagabine also decreased REM sleep, whereas pregabalin increased SE. Finally, levetiracetam did not affect SWS, REM sleep, and SE. CONCLUSIONS: This meta-analysis indicated that ASMs can have a statistically significant effect on sleep parameters; the effect differs between ASMs.

Recurrent Hypoglycemia-induced Hemiballism with Self-limited after Sleep - A Case Report.

PURPOSE: Hemiballism caused by hypoglycemia is rare. We presented a case who suffered from episodic hemiballism induced by hypoglycemia with spontaneously recovery after sleep. The possible mechanism of these self-limited episodes was also discussed. CASE REPORT: An 82-year-old female diabetic patient took oral anti-diabetic drugs (OADs) regularly. The doctor changed OADs doses and her appetite became poor before admission. She suffered from episodic left side involuntary movements with consciousness disturbance, and recovered spontaneously after a six-to-eight hour sleep in every attack at home. Very low finger sugar (20 mg/ dl) was noted while attack at admission. Brain computed tomography (CT), magnetic resonance imaging (MRI) and electroencephalography (EEG) were non-remarkable. Brain technetium-99mlabeled ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT) showed relative hyperperfusion over right side basal ganglion and thalamus. No further involuntary movement was observed after better sugar control. CONCLUSION: We suppose that sleep modify the glucose counterregulatory responses with increased growth hormone, which salvage hypoglycemic status in our presented case. With this report, we would like to draw clinicians' attention to including the treatable hypoglycemia state in the differential diagnosis of episodic involuntary movements.

Delayed onset diabetic striatopathy: Hemichorea-hemiballism one month after a hyperglycemic episode.

Diabetic striatopathy is an uncommon and life threatening manifestation of diabetes mellitus. It has a tendency to occur in the elderly, female and people of Asian descent. Patients usually present with hemichorea-hemiballism caused by non-ketotic hyperglycemia. However, patients could develop diabetic striatopathy weeks after the hyperglycemic event, even when blood sugar has been well controlled. Herein, we report a case of delayed onset diabetic striatopathy and discuss the importance of detailed history and brain magnetic resonance imaging for making prompt and accurate diagnosis.