**5. Results**

36 Novel Aspects on Epilepsy

Lamic. + + + + + + + + + + + Topir. + + + + + + + +

Zonis. +

Combination of three and more AEDs was used by 11 patients. Most commonly used combination of AEDs was carbamazepine/ valproate/lamotrigine, which used 7 pacientov,

Carbam. + + + + + + + + + + + +

Lamotrig. + + + + + + + + Topiramate + +

Benzodiaz. + Table 2. Combinations of three and more AEDs used in the group of patients with epilepsy. The relation of seizures and sleep or waking state was examined in all patients suffering from epilepsy. On this basis, patients were divided into two groups. The first group of 17 patients had seizures between 10.00 p.m. and 7.00 a.m. which means during sleep or on awakening. The second group of 83 patients had predominantly or exclusively seizures

Control group was composed by 80 healthy persons without anamnesis of epilepsy. They were admitted to the I. Neurology Clinic of Comenius University Hospital in Bratislava for low back pain and in time of evaluation were without pain, which could interfere with sleep. The group consisted of 45 women and 35 men with everage age 38,75 ±14,32 year,

The standard box-and-whisker plots were used for graphical representation of the parameter distribution in the particular groups of patients (Rousseeuw et al., 1999). Normality of data was verified by the Lilliefors test (Conover, 1999). To compare the observed parameters, the parametric method unpaired Student's group t-test was used

Valproate + + + + + + + + + + +

Levetirac. +

Clonazepam + +

Valpr. + + + + + + + + + + + + + + + + + +

Levet. + +

Table 1. Combinations of two AEDs used in the group of patients with epilepsy.

Carb. + + + + + + + + + + + + + + + +

Gabap + Pregab +

next combinations see in table 2.

related to waking hours.

including 17 - 78 years.

**4. Stastistical methods** 

**3.4 Characteristics of the control group** 

#### **5.1 Changes in daytime sleepiness**

Mean value of ESS in the group of patients with epilepsy was 7,11 ± 4,54, in control group 5,53 ± 2,15. Both mean values were in physiological range (under 9). Through that mean value of ESS was higher in group with epilepsy and the difference against control group was significant on p< 0,05 confirmed by all three used stastistical methods (see figure 4, table 3, 4). This result is assesed as significant tendency to daytime sleepiness in patients with epilepsy.

Fig. 4. Values of score Epworth Scale of Sleepiness (ESS) in the control group (0) and in the group of patients with epilepsy (1). The difference is statistically significant (p<0,05).


Table 3. Values of score ESS and statistical parameters in cotrol group and group of patients with epilepsy.


Table 4. Statistical comparison of values ESS by Students t-test, Kruskal-Wallis test a Kolmogorov-Smirnovov test. All result are statistically significant.

Daytime Sleepiness and Changes of Sleep in Patients with Epilepsy 39

**Eff. of sleep /%/ 1,3509E-07\* 6,23404E-07\* 3,84773E-05\*** 

**S2 /%/ 1,42639E-07\* 1,29334E-06\* 1,04321E-05\*** 

Table 5c. Comparison of observed characteristics in the control group and in the group of

Patients with epilepsy have significantly lower effectivity of sleep than healthy controls on statistical significance p< 0,001\* (see figure 5a). Furthermore patients with epilepsy have significantly more NREM S2 sleep, fewer REM sleep and have significantly longer latency to first REM sleep in comparison to healthy controls (see figures 5b, 5C, 5d). Other differences

Fig. 5a. Effecitvity of sleep in the control group (0) and in the group of patients with epilepsy

Significant changes in sleep architecture of patients with epilepsy were observed. Lower effectivity of sleep together with higher amount of NREM S2 sleep and fewer REM sleep

may have considerable consequences on quality of life of patients with epilepsy.

(1). The difference is statistically significant (p< 0,001).

**S1 /%/** 0,046 0,066 0,230

**S3,S4/%/** 0,179 0,163 0,304 **REM /%/ 0,004\* 0,001\* 0,0008\* Lat. to S1 /min/** 0,042 0,346 0,346 **Lat. to REM /min/ 0,013\* 0,047\* 0,004\*** 

**Kruskal-Wallis (p)** 

**Kolmogorov-Smirnov (p)** 

**t-Test (p)** 

patients with epilepsy

were not significant.

#### **5.2 Changes in sleep architecture**

In control group and group of patients with epilepsy statistical parameters as effectivity of sleep, amount of NREM S1, S2, S3+4, REM, latency to NREM S1 and latency to REM sleep were evaluated. Normality of distribution of data was tested by Lilliefors test and tests like Student's t-test, Kruskal-Wallis test and Kolmogor-Smirnov test were used (see tables 5a, 5b, 5c)


(SD – standard deviation)

Table 5a. Descriptive characteristics in the control group


(SD – standard deviation)

Table 5b. Descriptive characteristics in the group of patients with epilepsy

In control group and group of patients with epilepsy statistical parameters as effectivity of sleep, amount of NREM S1, S2, S3+4, REM, latency to NREM S1 and latency to REM sleep were evaluated. Normality of distribution of data was tested by Lilliefors test and tests like Student's t-test, Kruskal-Wallis test and Kolmogor-Smirnov test were used (see tables 5a,

**value** 

**sleep /%/** 80 87,38 9,89 50 99 90,5 0,001 **S1 /%/** 80 26,39 12,62 1,4 60,7 25,2 0,5 **S2 /%/** 80 29,40 10,10 12,3 49,9 28,7 0,14 **S3,S4 /%/** 80 21,02 9,34 0,1 48,9 19,35 0,002 **REM /%/** 80 23,06 9,96 0 47,8 24,95 0,02

**/min/** 80 27,58 28,18 2 123,5 15,5 0,001

**REM /min/** 79 132,64 67,04 21,5 372 118 0,001

**sleep /%/** 100 77,10 15,06 30 98 80 0,001 **S1 /%/** 99 22,75 11,29 1,3 48,5 21 0,34 **S2 /%/** 100 38,77 12,83 12,8 68,9 36,55 0,17 **S3,S4/%/** 100 19,13 9,28 0,23 43 17,95 0,003 **REM /%/** 100 18,82 9,06 1,9 54,3 18,05 0,30

**/min/** 100 41,55 60,23 1,5 386,5 20,5 0,001

Table 5b. Descriptive characteristics in the group of patients with epilepsy

**nubmer average SD Min value Max value Median Lilliefors** 

98 163,26 94,75 33 454,5 137 0,001

**Max** 

**value Median Lilliefors** 

**(p)** 

**(p)** 

**nubmer average SD Min** 

Table 5a. Descriptive characteristics in the control group

**5.2 Changes in sleep architecture** 

5b, 5c)

**Eff. of** 

**Lat. to S1** 

(SD – standard deviation)

**Lat. to** 

**Eff. of** 

**Lat. to S1** 

(SD – standard deviation)

**Lat. to REM /min/** 


Table 5c. Comparison of observed characteristics in the control group and in the group of patients with epilepsy

Patients with epilepsy have significantly lower effectivity of sleep than healthy controls on statistical significance p< 0,001\* (see figure 5a). Furthermore patients with epilepsy have significantly more NREM S2 sleep, fewer REM sleep and have significantly longer latency to first REM sleep in comparison to healthy controls (see figures 5b, 5C, 5d). Other differences were not significant.

Fig. 5a. Effecitvity of sleep in the control group (0) and in the group of patients with epilepsy (1). The difference is statistically significant (p< 0,001).

Significant changes in sleep architecture of patients with epilepsy were observed. Lower effectivity of sleep together with higher amount of NREM S2 sleep and fewer REM sleep may have considerable consequences on quality of life of patients with epilepsy.

Daytime Sleepiness and Changes of Sleep in Patients with Epilepsy 41

**5.3 Evaluation of factors with possible influence on sleep architecture of patients with** 

Some characteristics of epilepsy, like type of epilepsy, it's etiology, antiepileptic medication, actual compensation of seizures or evidence of ictal discharges may have influence on quality of sleep. We have chosen some of these factors with purpose to try to find reasons of different characteristics of sleep in patients with epilepsy. Parameters of ESS, MSLT and

**5.3.1 Influence of antiepileptic medication on daytine sleepiness and architecture of** 

Fig. 6a. Values of ESS in the group of patients with valproate (0), carbamazepine (1) and

As the next step, characteristics of daytime sleepiness and quality of sleep in the group of patients with monotherapy and the group of patients on two and more AEDs were evaluated and compared. We supposed, that combination of two and more AEDs could disturb night sleep and worsten daytime vigility. Group of patients using monotherapy consisted of 55 parients, in next group with more AEDs were 45 patients. Observed

lamotrigine (2). Differences are not statistically significant.

parameters are presented in tables 6a, 6b.

All patients with epilepsy in monitored group were treated by AEDs. As the first step 55 patients with monotherapy AEDs were evaluated. In this group 14 patients were treated by valproate, 31 patients by carbamazepine and 10 patients by lamotrigine. Parameters of ESS, MSLT, effectivity of sleep, % portions of sleep stages NREM S1, S2, S3+4, REM sleep and latency to NREM S1 sleep and latency to REM sleep were examined and statistically compared. No significant differences were ascertained, only patients treated by carbamazepine had higher score of ESS, more % portion of S1 NREM stage, less % portion of deep S3+S4 NREM sleep and had longer latency to first REM stage in comparison with patients treated only by valproate or lamotrigine (see figures 6a, 6b, 6c and 6d). These results may indicate some negative effect of carbamazepine on quality of daytime vigility

sleep macroarchitecture were evaluated and statistically compared.

**epilepsy** 

**sleep** 

and sleep.

Fig. 5b. Value of NREM S2 (%) in the control group (0) and in the group of patients with epilepsy (1). The difference is statistically significant (p< 0,001).

Fig. 5c., 5d. Value of REM (%) and latency to REM sleep (minutes) in the control group (0) and in the group of patients with epilepsy (1). The differences are statistically significant.

Fig. 5b. Value of NREM S2 (%) in the control group (0) and in the group of patients with

Fig. 5c., 5d. Value of REM (%) and latency to REM sleep (minutes) in the control group (0) and in the group of patients with epilepsy (1). The differences are statistically significant.

epilepsy (1). The difference is statistically significant (p< 0,001).

#### **5.3 Evaluation of factors with possible influence on sleep architecture of patients with epilepsy**

Some characteristics of epilepsy, like type of epilepsy, it's etiology, antiepileptic medication, actual compensation of seizures or evidence of ictal discharges may have influence on quality of sleep. We have chosen some of these factors with purpose to try to find reasons of different characteristics of sleep in patients with epilepsy. Parameters of ESS, MSLT and sleep macroarchitecture were evaluated and statistically compared.

#### **5.3.1 Influence of antiepileptic medication on daytine sleepiness and architecture of sleep**

All patients with epilepsy in monitored group were treated by AEDs. As the first step 55 patients with monotherapy AEDs were evaluated. In this group 14 patients were treated by valproate, 31 patients by carbamazepine and 10 patients by lamotrigine. Parameters of ESS, MSLT, effectivity of sleep, % portions of sleep stages NREM S1, S2, S3+4, REM sleep and latency to NREM S1 sleep and latency to REM sleep were examined and statistically compared. No significant differences were ascertained, only patients treated by carbamazepine had higher score of ESS, more % portion of S1 NREM stage, less % portion of deep S3+S4 NREM sleep and had longer latency to first REM stage in comparison with patients treated only by valproate or lamotrigine (see figures 6a, 6b, 6c and 6d). These results may indicate some negative effect of carbamazepine on quality of daytime vigility and sleep.

Fig. 6a. Values of ESS in the group of patients with valproate (0), carbamazepine (1) and lamotrigine (2). Differences are not statistically significant.

As the next step, characteristics of daytime sleepiness and quality of sleep in the group of patients with monotherapy and the group of patients on two and more AEDs were evaluated and compared. We supposed, that combination of two and more AEDs could disturb night sleep and worsten daytime vigility. Group of patients using monotherapy consisted of 55 parients, in next group with more AEDs were 45 patients. Observed parameters are presented in tables 6a, 6b.

Daytime Sleepiness and Changes of Sleep in Patients with Epilepsy 43

**ESS** 55 6,58 4,36 1 19 6 0,001

**/min/** 38 12,87 5,18 3,2 20 14,1 0,09

**sleep /%/** 55 76,45 15,08 30 98 79 0,012 **S1 /%/** 55 22,99 11,45 1,3 48,5 20,8 0,039 **S2 /%/** 55 38,39 13,29 15,3 67,9 36,7 0,5

**/%/** 55 18,50 9,63 0,23 40 17,3 0,23 **REM /%/** 55 19,75 9,79 1,9 54,3 20 0,40

**/min/** 55 40,12 58,08 1,5 386,5 18,5 0,001

Table 6a. Descriptive characteristics of patients with monotherapy of antiepileptic drugs.

**ESS** 45 7,88 4,73 0 21 8 0,46 **MSLT** 33 12,9 5,15 3,1 20 13,6 0,30

**/%/** 45 78,02 15,17 38 98 81 0,05 **S1 /%/** 45 22,39 11,20 1,6 46,6 23,3 0,23 **S2 /%/** 45 39,33 12,28 12,8 68,9 36,4 0,14

**/%/** 45 20,04 8,79 7,9 43 18,7 0,002

**/%/** 45 17,49 7,80 7,4 32,7 15,7 0,22

Table 6b. Descriptive characteristics of patients with therapy of two and more AEDs.

45 43,61 63,88 2 386,5 23,5 0,001

45 165,88 101,08 49 453 125 0,001

**number mean SD Min** 

55 161,38 90,79 33 454,5 139,5 0,002

**value** 

**Max** 

**value Median Lilliefors** 

**test (p)** 

**value** 

**Max** 

**value Median Lilliefors** 

**test (p)** 

 **number mean SD Min** 

**MSLT** 

**Eff. of** 

**S3+S4** 

**Lat. to S1** 

(SD –standard deviation)

**Lat. to REM /min/** 

**Ef.sp.** 

**S3+S4** 

**REM** 

**Lat.po S1 /min/** 

**Lat.po REM /min/** 

(SD –standard deviation)

Fig. 6b., 6c. Portion of S1 NREM sleep and S3+S4 NREM sleep in the group of patients with valproate (0), carbamazepine (1) and lamotrigine (2). Differences are not statistically significant.

Fig. 6d. Latency to first REM sleep in the group of patients with valproate (0), carbamazepine (1) and lamotrigine (2). Differences are not statistically significant.


(SD –standard deviation)

42 Novel Aspects on Epilepsy

Fig. 6b., 6c. Portion of S1 NREM sleep and S3+S4 NREM sleep in the group of patients with valproate (0), carbamazepine (1) and lamotrigine (2). Differences are not statistically

Fig. 6d. Latency to first REM sleep in the group of patients with valproate (0), carbamazepine (1) and lamotrigine (2). Differences are not statistically significant.

significant.

Table 6a. Descriptive characteristics of patients with monotherapy of antiepileptic drugs.


(SD –standard deviation)

Table 6b. Descriptive characteristics of patients with therapy of two and more AEDs.

Daytime Sleepiness and Changes of Sleep in Patients with Epilepsy 45

generalized epilepsies have also different influence on sleep architecture. Group of 100 patients with epilepsy was divided in two groups. Group of patients with focal epilepsy inclosed 76 patients, in group of generalized epilepsy were 24 patients. Tables 7a, 7b and 7c

**number mean SD Min value Max value Median Lilliefors test** 

<sup>5</sup>36 454,5 125 0,001

**(p)** 

**(p)** 

describe results of ESS, MSLT, effectivity of sleep and other characteristics of sleep.

**ESS** 76 7,22 4,50 0 21 6 0,008 **MSLT** 56 12,64 5,02 3,1 20 13,15 0,30

**sleep /%/** 76 78,60 13,78 38 98 81 0,007 **S1 /%/** 75 23,88 11,54 1,3 48,5 22,9 0,5 **S2 /%/** 76 39,34 12,88 12,8 68,9 36,95 0,14 **S3+S4 /%/** 76 17,80 8,61 0,23 43 17,1 0,006 **REM /%/** 76 18,79 9,55 1,9 54,3 17,45 0,37

**/min/** 76 36,67 52,87 1,5 386,5 18,5 0,001

 **numbert mean SD Min value Max value Median Lilliefors test** 

**ESS** 24 6,75 4,73 0 15 5,5 0,05 **MSLT** 15 13,79 5,59 3,2 20 15 0,05

**sleep /%/** 24 72,32 18,07 30 98 76,5 0,45 **S1 /%/** 24 19,22 9,89 3,1 39,8 19,9 0,50 **S2 /%/** 24 36,97 12,77 15,3 57,4 35,65 0,50 **S3+S4 /%/** 24 23,35 10,23 2,5 40 21,9 0,33 **REM** 24 18,92 7,47 6,9 34,8 19,1 0,50

**/min/** 24 57 78,58 3 386,5 36,75 0,001

Table 7b. Descriptive characteristics of group with primary generalized epilepsy.

23 155,61 71,81 33 333 139,5 0,05

75 165,61 101,0

Table 7a. Descriptive characteristics of group with focal epilepsy.

**Eff. of** 

**Lat. to S1** 

**Lat. to REM /min/** 

**Eff.of** 

**Lat. to S1** 

**Lat. to REM /min/** 


Table 6c shows statistical comparison of evaluated parameters in both groups. Differences are not significant.

Table 6c. Comparison of observed parameters in the group of patients on monotherapy and the group with two and more AEDs.

Though patients in the group with combination of AEDs have lightly elevated score ESS (ESS 7,88 ± 4,74) in comparison of patients on monotherapy (ESS 6,58 ± 4,36), the difference was not significant (see figure 7). Neither of other evaluated differences was significantly different.

Fig. 7. Values of ESS in the group with monotperapy (0) and the group with two and more AEDs (1). The difference is not significant.

#### **5.3.2 Influence of type of epilepsy (focal/generalized) on daytime sleepiness and quality of sleep**

Epileptogenesis of focal and generalized epilepsy is diverse. In focal epilepsy epileptic discharge is localizated and placement of epileptic focus is important as well as possible secondary generalization. Primary generalized epilepsies have different mechanism of epileptigenesis with involvement of bigger areas of the brain. It was expected, that focal and

Table 6c shows statistical comparison of evaluated parameters in both groups. Differences

**ESS** 0,17 0,12 0,06 **MSLT** 0,98 0,96 0,10 **Eff. of sleep /%/** 0,61 0,49 0,90 **NREM S1 /%/** 0,79 0,88 0,72 **NREM S2 /%/** 0,72 0,96 0,57 **NREM S3+S4 /%/** 0,41 0,50 0,66 **REM /%/** 0,20 0,29 0,28 **Lat. to S1 /min/** 0,78 0,63 0,63 **Lat. to REM /min/** 0,82 0,10 0,89

Table 6c. Comparison of observed parameters in the group of patients on monotherapy and

Though patients in the group with combination of AEDs have lightly elevated score ESS (ESS 7,88 ± 4,74) in comparison of patients on monotherapy (ESS 6,58 ± 4,36), the difference was not significant (see figure 7). Neither of other evaluated differences was significantly

Fig. 7. Values of ESS in the group with monotperapy (0) and the group with two and more

Epileptogenesis of focal and generalized epilepsy is diverse. In focal epilepsy epileptic discharge is localizated and placement of epileptic focus is important as well as possible secondary generalization. Primary generalized epilepsies have different mechanism of epileptigenesis with involvement of bigger areas of the brain. It was expected, that focal and

**5.3.2 Influence of type of epilepsy (focal/generalized) on daytime sleepiness and** 

**Kruskal-Wallis (p)** 

**Kolmogor-Smirnov (p)** 

**t-Test (p)** 

are not significant.

the group with two and more AEDs.

AEDs (1). The difference is not significant.

**quality of sleep** 

different.

generalized epilepsies have also different influence on sleep architecture. Group of 100 patients with epilepsy was divided in two groups. Group of patients with focal epilepsy inclosed 76 patients, in group of generalized epilepsy were 24 patients. Tables 7a, 7b and 7c describe results of ESS, MSLT, effectivity of sleep and other characteristics of sleep.


Table 7a. Descriptive characteristics of group with focal epilepsy.


Table 7b. Descriptive characteristics of group with primary generalized epilepsy.

Daytime Sleepiness and Changes of Sleep in Patients with Epilepsy 47

Fig. 8b. Portion of S3+S4 NERM sleep in the group of focal epilepsy (0) and the group of

Localization of epileptic focus in the group of patients with focal epilepsy was determined by EEG evaluation. Correct localization of epileptic focus was possible by 72 patients. The

Group of 72 patients was divided into two parts. In the first group 61 patients had focus in temporal or temporoparietal region. Next group of 11 patients had focus in frontal or frontotemporal region. Characteristics of daytime vigility and night sleep were compared in

**ESS** 61 7,28 4,39 0 19 6 0,02 **MSLT** 44 12,20 4,84 4,5 20 11,9 0,42

**sleep /%/** 61 78,36 13,49 38 98 81 0,002 **S1 /%/** 60 23,34 11,83 1,3 48,5 21,9 0,50 **S2 /%/** 61 39,21 13,03 12,8 68,9 36,7 0,14

**/%/** 61 17,84 8,90 0,23 43 16,9 0,002 **REM /%/** 61 19,40 9,86 1,9 54,3 18,8 0,50

**/min/** 61 38,09 56,28 1,5 386,5 19,5 0,001

Table 8a. Descriptive characteristisc of group with temporal, or temporoparietal focus.

60 163,59 97,35 36 454,5 135 0,007

**Number Mean SD Min value Max value Median Lilliefors** 

**test (p)** 

**5.3.3 Influence of localization of epileptic focus on daytime sleepiness and** 

generalized epilepsy (1). The difference is statistically significant.

rest of patients had multiple foci or normal EEG.

both groups. Results are presented in tables 8a, 8b and 8c.

**architecture of sleep** 

**Eff. of** 

**S3+S4** 

**Lat. to S1** 

(SD –standard deviation)

**Lat. to REM /min/** 


Table 7c. Comparison of observed parameters in the group with focal epilepsy and the group with generalized epilepsy.

It was detected, that patients with generalized epilepsy have lower effectivity of sleep and patients with focal epilepsy have fewer deep sleep stages of NREM sleep. These differences are statistically significant. Figures 8a, 8b show these results.

This may be result of different mechanism of epileptogenesis in both types of epilepsy, though further study should be done to exlpain these differences.

Fig. 8a. Effectivity of sleep in the group of focal epilepsy (0) and the group of generalized epilepsy (1). The difference is statistically significant.

**ESS** 0,67 0,61 0,89

**MSLT** 0,48 0,37 0,45

**Eff. of sleep /%/ 0,02\* 0,01\* 0,005\*** 

**NREM S1 /%/** 0,06 0,10 0,43

**NREM S2 /%/** 0,43 0,50 0,36

**NREM S3+S4 /%/ 0,02\* 0,01\* 0,008\*** 

**REM /%/** 0,94 0,69 0,82

**Lat. to S1 /min/** 0,24 0,09 0,16

**Lat. to REM /min/** 0,61 0,74 0,42

are statistically significant. Figures 8a, 8b show these results.

epilepsy (1). The difference is statistically significant.

though further study should be done to exlpain these differences.

group with generalized epilepsy.

Table 7c. Comparison of observed parameters in the group with focal epilepsy and the

It was detected, that patients with generalized epilepsy have lower effectivity of sleep and patients with focal epilepsy have fewer deep sleep stages of NREM sleep. These differences

This may be result of different mechanism of epileptogenesis in both types of epilepsy,

Fig. 8a. Effectivity of sleep in the group of focal epilepsy (0) and the group of generalized

**Kruskal-Wallis (p)** 

**Kolmogor-Smirnov (p)** 

**t-test (p)** 

Fig. 8b. Portion of S3+S4 NERM sleep in the group of focal epilepsy (0) and the group of generalized epilepsy (1). The difference is statistically significant.

#### **5.3.3 Influence of localization of epileptic focus on daytime sleepiness and architecture of sleep**

Localization of epileptic focus in the group of patients with focal epilepsy was determined by EEG evaluation. Correct localization of epileptic focus was possible by 72 patients. The rest of patients had multiple foci or normal EEG.

Group of 72 patients was divided into two parts. In the first group 61 patients had focus in temporal or temporoparietal region. Next group of 11 patients had focus in frontal or frontotemporal region. Characteristics of daytime vigility and night sleep were compared in both groups. Results are presented in tables 8a, 8b and 8c.


(SD –standard deviation)

Table 8a. Descriptive characteristisc of group with temporal, or temporoparietal focus.

Daytime Sleepiness and Changes of Sleep in Patients with Epilepsy 49

Fig. 9. Mean values of latencies in MSLT in the group with temporal or temporoparietal focus (0) and in the group with frontal and frontotemporal focus (1). The difference is

Patients in our study as well as control group didn't have elevated daytime sleepiness according to results of Epworth scale of sleepiness (ESS). This result is in accordance with literature, where ESS of epileptic patients and healthy controls did not differ significantly (Malow et al., 1997; Manni et al., 2000; Watanabe et al., 2003). Patients with epilepsy in our group had significantly higher score of ESS than control group. This result was assessed as

Reason of tendency to problems with vigility in epileptic patients is probably multifactorial. We suppose that detemining cause is fragmentation of sleep architecture with failure of its restorative functions. We found out significant changes in sleep architecture of epileptic patients, which correlate with literature data (Bazil, 2003; Niedermeyer, 1982; Sammaritano et al., 1994; Touchon et al., 1991), as significantly lower effectivity of sleep, significantly more NREM S2 stage sleep, fewer REM sleep and longer latency to REM sleep. According to literature these changes are caused by epileptic seizures, antiepileptic therapy and severity of epilepsy (Bazil, Malow & Sammaritano, 2002). We did not prove influence of antiepileptic therapy on quality of sleep and daytime vigility. This might be influenced by that patients were using medication for longer time before evaluation. Further evaluation should be done in this area to determine influence of specific antiepileptic drugs on sleep architecture. According to different mechanizms of epileptogenesis in focal and generalized epilepsies various centers of brain involved in regulation of sleep may be influenced (Faber, 1995). This probably correlates with our results of significant reduction of S3 and S4 NREM sleep in the group of patients with focal epilepsy and significant decrement of effectivity of sleep in patients with generalized epilepsy. Changes of sleep in focal epilepsy are probably influenced by localization and ethiology of laesion, in generalized epilepsy thalamocortical

circuits involved in epileptogenesis probably influence wider areas of brain.

That is why localization of epileptic focus was also evaluated in correlation with daytime sleepiness and quality of sleep. Significantly shorter mean latency in MSLT was detected in patients with temporal focus in comparison with patients with extratemporal epileptic focus.

tendency to daytime sleepiness in patients with epilepsy.

significant.

**6. Discussion** 


Table 8b. Descriptive characteristisc of group with frontal of frontotemporal focus.


Table 8c. Comparison of observed parameters in the group with temporal or temporoparietal focus and the group with frontal or frontotemporal focus.

Kolmogov-Smirnov test showed significant difference in mean latency of sleep by MSLT as patients with temporal or temporoparietal focus have significantly shorter time in MSLT in comparison with group of patients with frontal or frontotemporal focus (see figure 9). Though medians of both MSLT tests are in normal range ( > 10 minutes), distribution of datas in the group with temporal and temporoparietal localization of focus is more disperzed as well as values of short mean latency are presented. This may indicate some tendency to elevated daytime sleepiness in the group of patients with temporal or temporoparietal localization of epileptic focus.

Fig. 9. Mean values of latencies in MSLT in the group with temporal or temporoparietal focus (0) and in the group with frontal and frontotemporal focus (1). The difference is significant.

#### **6. Discussion**

48 Novel Aspects on Epilepsy

**ESS** 11 7,54 5,25 1 21 7 0,48 **MSLT** 9 14,27 5,57 3,1 20 15,25 0,03

**S1 /%/** 11 26,32 9,63 11,6 40 24,9 0,50 **S2 /%/** 11 41,02 12,90 15,9 67,9 37,8 0,39

**/%/** 11 17,13 8,05 1,1 30,6 17,1 0,50

**/%/** 11 15,47 7,87 5,1 32,7 15 0,50

**S1 /min/** 11 25,50 25,74 1,5 97 17 0,07

Table 8b. Descriptive characteristisc of group with frontal of frontotemporal focus.

**ESS** 0,87 0,98 0,99 **MSLT** 0,26 0,19 **0,04\* Ef.sp. /%/** 0,88 0,93 0,77 **S1 /%/** 0,34 0,28 0,66 **S2 /%/** 0,65 0,53 0,51 **S3+S4 /%/** 0,78 0,96 0,96 **REM /%/** 0,13 0,19 0,52 **Lat. to S1 /min/** 0,22 0,68 0,76 **Lat. to REM /min/** 0,98 0,80 0,94

Table 8c. Comparison of observed parameters in the group with temporal or temporoparietal focus and the group with frontal or frontotemporal focus.

temporoparietal localization of epileptic focus.

Kolmogov-Smirnov test showed significant difference in mean latency of sleep by MSLT as patients with temporal or temporoparietal focus have significantly shorter time in MSLT in comparison with group of patients with frontal or frontotemporal focus (see figure 9). Though medians of both MSLT tests are in normal range ( > 10 minutes), distribution of datas in the group with temporal and temporoparietal localization of focus is more disperzed as well as values of short mean latency are presented. This may indicate some tendency to elevated daytime sleepiness in the group of patients with temporal or

**t-test (p)** 

**Eff. of sleep /%/** 

**S3+S4** 

**REM** 

**Lat. to** 

**Lat. to REM /min/** 

**Number Mean SD Min value Max value Median Lilliefors** 

11 79,08 15,47 50 98 79 0,22

11 164,39 114,51 36 378 112,5 0,03

**Kruskal-Wallis (p)** 

**test (p)** 

**Kolmogor-Smirnov (p)** 

Patients in our study as well as control group didn't have elevated daytime sleepiness according to results of Epworth scale of sleepiness (ESS). This result is in accordance with literature, where ESS of epileptic patients and healthy controls did not differ significantly (Malow et al., 1997; Manni et al., 2000; Watanabe et al., 2003). Patients with epilepsy in our group had significantly higher score of ESS than control group. This result was assessed as tendency to daytime sleepiness in patients with epilepsy.

Reason of tendency to problems with vigility in epileptic patients is probably multifactorial. We suppose that detemining cause is fragmentation of sleep architecture with failure of its restorative functions. We found out significant changes in sleep architecture of epileptic patients, which correlate with literature data (Bazil, 2003; Niedermeyer, 1982; Sammaritano et al., 1994; Touchon et al., 1991), as significantly lower effectivity of sleep, significantly more NREM S2 stage sleep, fewer REM sleep and longer latency to REM sleep. According to literature these changes are caused by epileptic seizures, antiepileptic therapy and severity of epilepsy (Bazil, Malow & Sammaritano, 2002). We did not prove influence of antiepileptic therapy on quality of sleep and daytime vigility. This might be influenced by that patients were using medication for longer time before evaluation. Further evaluation should be done in this area to determine influence of specific antiepileptic drugs on sleep architecture.

According to different mechanizms of epileptogenesis in focal and generalized epilepsies various centers of brain involved in regulation of sleep may be influenced (Faber, 1995). This probably correlates with our results of significant reduction of S3 and S4 NREM sleep in the group of patients with focal epilepsy and significant decrement of effectivity of sleep in patients with generalized epilepsy. Changes of sleep in focal epilepsy are probably influenced by localization and ethiology of laesion, in generalized epilepsy thalamocortical circuits involved in epileptogenesis probably influence wider areas of brain.

That is why localization of epileptic focus was also evaluated in correlation with daytime sleepiness and quality of sleep. Significantly shorter mean latency in MSLT was detected in patients with temporal focus in comparison with patients with extratemporal epileptic focus.

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