Sleep, Circadian Rhythms, and Epilepsy.

PURPOSE OF REVIEW: There is a known interrelationship between sleep and epilepsy. This review highlights the recent findings regarding interactions between sleep and circadian rhythms and the manifestations of epilepsy and surgical treatments for refractory epilepsy. RECENT FINDINGS: CLOCK gene expression may be reduced within the epileptogenic focus in patients with refractory epilepsy. Interictal epileptiform discharges during NREM and especially REM sleep may lateralize to the epileptogenic hemisphere. Intracranial video EEG monitoring and EEG from implanted responsive neurostimulator devices confirm scalp video EEG findings of a nocturnal peak for interictal epileptiform discharges. Successful epilepsy surgery may improve sleep macrostructure and quality. Sleep outcomes in people with epilepsy undergoing epilepsy surgery and neurostimulator implantation may provide innovative understandings into the associations between sleep and epilepsy. These associations may then provide novel therapeutic options targeting sleep and circadian pathways to improve seizure control and improve the quality of life for patients with this debilitating disorder.

Surface EMG activity during REM sleep in Parkinson's disease correlates with disease severity.

OBJECTIVES: Over 40% of individuals with Parkinson's disease (PD) have rapid eye movement sleep behavior disorder (RBD). This is associated with excessive sustained (tonic) or intermittent (phasic) muscle activity instead of the muscle atonia normally seen during REM sleep. We examined characteristics of manually-quantitated surface EMG activity in PD to ascertain whether the extent of muscle activity during REM sleep is associated with specific clinical features and measures of disease severity. METHODS: In a convenience sample of outpatients with idiopathic PD, REM sleep behavior disorder was diagnosed based on clinical history and polysomnogram, and severity was measured using the RBD sleep questionnaire. Surface EMG activity in the mentalis, extensor muscle group of the forearms, and anterior tibialis was manually quantitated. Percentage of REM time with excessive tonic or phasic muscle activity was calculated and compared across PD and RBD characteristics. RESULTS: Among 65 patients, 31 had confirmed RBD. In univariate analyses, higher amounts of surface EMG activity were associated with longer PD disease duration (srho = 0.34; p = 0.006) and greater disease severity (p < 0.001). In a multivariate regression model, surface EMG activity was significantly associated with RBD severity (p < 0.001) after adjustment for age, PD disease duration, PD severity and co-morbid sleep abnormalities. CONCLUSION: Surface EMG activity during REM sleep was associated with severity of both PD and RBD. This measure may be useful as a PD biomarker and, if confirmed, may aid in determining which PD patients warrant treatment for their dream enactment to reduce risk of injury.

Prolonged assessment of sleep and daytime sleepiness in unrestrained Macaca mulatta.

STUDY OBJECTIVE: To establish a method for the prolonged recording of electrophysiologic variables of sleep in freely moving nonhuman primates. To establish and validate means for scoring nocturnal sleep and quantifying daytime alertness in these subjects. DESIGN: Four animals (M. mulatta) were permanently instrumented for the recording of electroencephalograms, electrooculograms, and electromyograms. A telemetry unit housed in a backpack transmitted these variables for several overnight periods to establish normal sleep. During the day, a modified Multiple Sleep Latency Test protocol was followed to quantify daytime alertness. High-quality recordings were maintained from a minimum of 8 months to a maximum of 5.5 years. MEASUREMENTS AND RESULTS: Across 6 to 7 nights per animal, average total sleep time was 522 minutes, with a sleep latency of 20 minutes. The proportion of total sleep spent in the various stages of sleep was 10.8%, stage 1; 56.4%, stage 2; 20.0%, stages 3-4; and 12.7%, rapid eye movement sleep. Mean sleep latency across testing sessions for each monkey was 12.5 minutes, 20 minutes (no daytime sleep), 14.6 minutes, and 8.6 minutes for animals 1 to 4, respectively. Intrarater and interrater reliabilities were high and similar to those obtained when the same scorers evaluated human sleep and Multiple Sleep Latency Tests. CONCLUSIONS: Similarities in sleep architecture between M. mulatta and humans make this an excellent animal model for investigations of normal and pathologic human sleep. This study confirms and extends previous findings in nonhuman primates. Stable, high-quality data were obtained for months to years using a telemetric system capable of long-term data collection.