Garg Divyani, Charlesworth Laurel, Shukla Garima
Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Division of Sleep Medicine, Queen's University, Kingston, ON, Canada.
Front Hum Neurosci. 2022 Apr 26;16:849899. doi: 10.3389/fnhum.2022.849899. eCollection 2022.
In this systematic review, we aim to describe the association between temporal lobe epilepsy (TLE) and sleep, with bidirectional links in mechanisms and therapeutic aspects. Sleep stages may variably impact seizure occurrence, secondary generalization and the development, frequency and distribution of interictal epileptiform discharges. Conversely, epilepsy affects sleep micro- and macroarchitecture. TLE, the most frequent form of drug resistant epilepsy (DRE), shares an enduring relationship with sleep, with some intriguing potential mechanisms specific to anatomic localization, linking the two. Sleep characteristics of TLE may also inform localizing properties in persons with DRE, since seizures arising from the temporal lobe seem to be more common during wakefulness, compared to seizures of extratemporal origin. Polysomnographic studies indicate that persons with TLE may experience excessive daytime somnolence, disrupted sleep architecture, increased wake after sleep onset, frequent shifts in sleep stages, lower sleep efficiency, decreased rapid eye movement (REM) sleep, and possibly, increased incidence of sleep apnea. Limited literature suggests that effective epilepsy surgery may remedy many of these objective and subjective sleep-related concerns, multipronged effects, apart from reduced seizure frequency. Additionally, sleep abnormalities also seem to influence memory, language and cognitive-executive function in both medically controlled and refractory TLE. Another aspect of the relationship pertains to anti-seizure medications (ASMs), which may contribute significantly to sleep characteristics and abnormalities in persons with TLE. Literature focused on specific aspects of TLE and sleep is limited, and heterogeneous. Future investigations are essential to understand the pathogenetic mechanisms linking sleep abnormalities on epilepsy outcomes in the important sub-population of TLE.
在本系统评价中，我们旨在描述颞叶癫痫（TLE）与睡眠之间的关联，包括机制和治疗方面的双向联系。睡眠阶段可能会对癫痫发作的发生、继发性泛化以及发作间期癫痫样放电的发展、频率和分布产生不同程度的影响。反之，癫痫也会影响睡眠的微观和宏观结构。TLE是药物难治性癫痫（DRE）最常见的形式，它与睡眠有着持久的关系，存在一些特定于解剖定位的有趣潜在机制将两者联系起来。TLE的睡眠特征也可能为DRE患者的定位特性提供线索，因为与颞叶外起源的癫痫发作相比，起源于颞叶的癫痫发作似乎在清醒时更为常见。多导睡眠图研究表明，TLE患者可能会出现白天过度嗜睡、睡眠结构紊乱、睡眠开始后觉醒增加、睡眠阶段频繁转换、睡眠效率降低、快速眼动（REM）睡眠减少，以及可能的睡眠呼吸暂停发生率增加。有限的文献表明，有效的癫痫手术除了能降低癫痫发作频率外，还可能改善许多这些与睡眠相关的客观和主观问题。此外，睡眠异常似乎也会影响药物控制的和难治性TLE患者的记忆、语言和认知执行功能。这种关系的另一个方面涉及抗癫痫药物（ASM），它可能对TLE患者的睡眠特征和异常有显著影响。专注于TLE与睡眠特定方面的文献有限且存在异质性。未来的研究对于理解在TLE这一重要亚群中睡眠异常与癫痫结局之间的发病机制至关重要。
