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Kinder- und Jugendmedizin 2019; 19(03): 186-193
DOI: 10.1055/a-0874-8181
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Schlaf und Epilepsie

Sleep and epilepsy
Bernhard Schmitt∗
1   Neuropädiatrie, Universitäts-Kinderspital, Zürich, Schweiz
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Publication History

eingereicht 24 January 2019

akzeptiert 01 February 2019

Publication Date:
18 June 2019 (online)

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Zusammenfassung

Schlaf und Epilepsie stehen in enger Beziehung zueinander. 20 % der Epilepsiepatienten erleiden Anfälle nur in der Nacht, 40 % nur am Tag und 35 % bei Tag und Nacht. Kinder mit Panayiotopoulos-Syndrom oder Rolando-Epilepsie erleiden ihre Anfälle vorwiegend im Schlaf und zeigen im NREM-Schlaf eine Zunahme der Spike-waves. ESES (elektrischer Status epilepticus im Schlaf) und Landau-Kleffner-Syndrom sind epileptische Enzephalopathien mit ausgeprägten kognitiven Einbrüchen, Verhaltensauffälligkeiten und Anfällen. Kennzeichnend ist eine kontinuierliche Spike-wave-Aktivität im NREM-Schlaf. Patienten mit juveniler Myoklonusepilepsie oder Aufwach-Grand-Mal-Epilepsie haben ihre Anfälle nach dem Aufwachen, nicht selten nach vorausgehendem Schlafentzug. Nächtliche Frontallappen-Anfälle werden oft mit Parasomnien verwechselt. Für eine korrekte Zuordnung ist es hilfreich, die klinische Symptomatik und die Häufigkeit pro Nacht und Monat in die Beurteilung mit einzubeziehen. Nächtliche Anfälle und Antikonvulsiva wirken sich auf den Schlaf aus. Schlafstörungen sollten erkannt und behandelt werden, da dies die Anfallskontrolle und Lebensqualität verbessern kann. Bei Verdacht auf Epilepsie und nicht schlüssigem Wach-EEG können Schlaf-EEGs hilfreich sein. Abhängig von der Fragestellung kann das EEG im Mittagsschlaf (natürlicher Schlaf oder medikamentös induziert), während der Nacht oder nach vorausgehendem Schlafentzug stattfinden.

Abstract

Sleep and epilepsy have a close relationship. 20 % of patients suffer seizures only during the night, 40 % only during the day and 35 % during day and night. In certain epilepsy syndromes, the occurrence of seizures is strongly related to sleep or awakening. Children with Panayiotopoulos syndrome or Rolandic epilepsy have seizures mostly when asleep, and in both syndromes interictal spike-waves are markedly accentuated in NREM sleep. ESES (electrical status epilepticus in sleep) and Landau-Kleffner syndrome are epileptic encephalopathies with substantial behavioural and cognitive deficits, various seizures, and continuous spike-waves during NREM sleep. The hallmark of juvenile myoclonic epilepsy or grand mal seizures on awakening are seizures within two hours after awakening, often provoked by sleep deprivation. Nocturnal frontal lobe epilepsy is sometimes mistaken for parasomnia. Differentiation is possible when the clinical symptoms and the frequency of the paroxysmal events per night and month are carefully observed and nocturnal video-EEG performed.

Sleep can be affected by nocturnal seizures and anticonvulsants. Identifying and treating sleep disorders may lead to improved seizure control and better quality of life. EEG recordings in sleep may be helpful in patients with suspected epilepsy and non-conclusive awake EEG. Depending on the clinical question, sleep recordings should be performed during nap (natural sleep or drug induced), during the night, or after sleep deprivation.

Schlüsselwörter

Schlaf - Epilepsie - Spike-waves

Key words

Sleep - epilepsy - spike-waves
 

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