**5. Pediatric epilepsy associated with sleep**

### **5.1 Generalized epilepsies**

### *5.1.1 Absence epilepsy*

Absence seizures clinically present as a brief transitory behavioral arrest lasting a few seconds that is detectable while patient is awake and typically triggered by hyperventilation, and less often by photic stimulation [23]. Typical EEG shows a generalized 3-Hz spike-wave complexes. The activation of the IEA is most marked in the first sleep cycle [24]. Absence seizures are often inhibited by full wakefulness and REM sleep. During NREM slow-wave sleep the cell activity is more synchronous and allows the activation of spike-wave responses, whereas during REM, a traditional desynchronization state, spike and wave are uncommon [25]. The spike and waves present during NREM state differ also from wakefulness IEDs because they are briefer, more fragmented, more irregular, and slower than during wakefulness [20].

### *5.1.2 West syndrome*

West Syndrome is characterized by the triad of infantile spasms, psychomotor retardation, and hypsarrhythmia in the EEG. Hypsarrhythmia is characterized by chaotic and disorganized background of high voltage, asynchronous spike and slow-wave activity [26]. Only 2-5% of the spams occurred during sleep despite increase in EEG abnormalities during NREM sleep [27]. The hypsarrhythmia pattern may become more apparent during sleep. During REM sleep, a marked attenuation or disappearance of the hypsarrhythmia pattern is noted [28]. Treatment of Infantile spasms includes ACTH, prednisone, and vigabatrin. Vigabatrin [gamma vinyl, gamma-aminobutyric acid (GABA)] is a specific, irreversible inhibitor of GABA-transaminase. Other treatment includes Zonisamide, Topiramate, Valproic acid, Nitrazepam, Pyridoxine, and Ketogenic diet. Surgery

**41**

**Table 1.**

*Sleep Disorders and Epilepsy*

*DOI: http://dx.doi.org/10.5772/intechopen.93989*

times per night, but absent during REM sleep [23].

evidence of structural abnormality.

*5.1.3 Lennox – Gastaut syndrome*

**5.2 Focal epilepsies**

epilepsy.

*5.2.1 Frontal lobe epilepsy*

Early hyper-motor activity

Minimal or no post-ictal period

Often secondarily generalized

*General features of frontal lobe seizures.*

Short duration

Presence in clusters

Occurrence at night

should be considered in cases with asymmetric spasm, focal neurologic abnormalities on examination, EEG with focal or lateralizing features, and radiologic

Lennox-Gastaut's syndrome [LGS] usually begins in the first decade of life and is characterized by multiple types of primary generalized seizures, including prominent nocturnal tonic, astatic/atonic, atypical absence, myoclonic, and generalized tonic-clonic seizures with associated psychomotor and cognitive delay. It is often preceded by a history of infantile spasms with hypsarrhythmia in the EEG. Typical EEG shows slow spike-wave [SSW] complexes at 1.5-2.5 Hz, multifocal epileptiform abnormalities, paroxysmal fast activity, and diffuse background slowing. The quantity of the bursts of SSW complexes increases during NREM sleep [29]. Paroxysmal fast activity is a typical pattern of LGS characterized by diffuse bursts activity with a frequency of 15-20 Hz, mainly during NREM with an occurrence up to hundred

Frontal lobe epilepsy [FLE] is the second most common focal epilepsy. Seizures with origin in the frontal lobe tend to occur preferentially during sleep and have prominent motor features, often recognized by family members or friends, **Table 1**. There are two very distinct epileptic syndromes that characterized frontal lobe seizure. They are known as nocturnal frontal lobe epilepsy and supplementary sensorimotor area

Nocturnal frontal lobe epilepsy (NFLE) predominates in male, typically with onset in infancy through adolescence, and is familial in 6-40% of the cases [30–32]. It is characterized by paroxysmal arousals with brief hypermotor features, motor attacks with complex dystonic and dyskinetic movements, and/or episodic nocturnal wandering that mimics the NREM parasomnia called sleepwalking. NFLE usually presents with multiple attacks per night. Video-EEG polysomnography is necessary for definitive diagnosis. Approximately 50% of the cases have normal ictal or interictal EEGs. NFLE usually respond to carbamazepine, but cases of

Supplementary sensorimotor area (SSMA) epilepsy is another unique subtype

of frontal lobe epilepsy. Seizures characteristically begin with somatosensory auras progressing to a "fencing" posture with the arm contralateral to seizure

medically intractable NFLE have been well established [30–33].

should be considered in cases with asymmetric spasm, focal neurologic abnormalities on examination, EEG with focal or lateralizing features, and radiologic evidence of structural abnormality.
