The interactions between sleep and epilepsy are important for clinical management of children as well as for theoretic models to understand how the brain controls rapid physiologic changes during state alteration, how it responds to external stimuli during sleep, and how potential seizures are prevented by restricting the epileptogenic zone. Sleep itself has an important effect on the clinical and electrographic findings in different pediatric seizure types and epilepsy syndromes. Some seizure disorders are activated by drowsiness and sleep, and the transition between sleep anti wakefulness is an important trigger for epilepsy. Each pediatric seizure disorder shows a characteristic profile of epileptiform activity in relation to the sleep/wake cycle. This predictable relationship can aid in defining seizure type and allow the clinician to order a diagnostic EEG at a time most likely to lead to proper diagnosis. Furthermore, the characteristic features of sleep are altered by the presence of epilepsy, antiepileptic medication, and the underlying abnormal neuroanatomic substrate. Epilepsy can be misdiagnosed as a sleep disorder. It is unfortunate when a treatable seizure disorder is managed inappropriately with stimulants, psychotherapy, family counseling, or planned awakenings from sleep (Table 2). Seizures definitely account for some nocturnal arousals, even in individuals with normal EEG findings during the attack Steep disorders can be misdiagnosed as epilepsy: It is inappropriate to treat parasomnias or narcolepsy with anticonvulsants. There are complicated situations in which obstructive sleep apnea or another primary sleep disorder contributes to an underlying seizure disorder. Diagnostic dilemmas often can be clarified by a careful history and appropriate investigations including full polysomnography with video EEG.
Brown, L. W. (1996). Sleep and epilepsy. Child and Adolescent Psychiatric Clinics of North America. https://doi.org/10.2174/978160805267710072