ANNOUNCER: It is also important to identify sleep-related epilepsy because lack of sleep, in and of itself, is a known cause of increased seizure activity.
CARL BAZIL, MD, PhD: One of the things that we worry about with sleep-related epilepsy is that patients can develop a vicious cycle. They become sleep deprived, they have more seizures, and seizures actually will cause sleep disruption. So they can get into this vicious cycle of seizures and sleep deprivation where it's impossible to completely control the seizures.
ANNOUNCER: Once sleep-related epilepsy is diagnosed, there are a large number of medications that can be effectively used.
CARL BAZIL, MD, PhD: Sleep-related epilepsy isn't that different from epilepsy in general. It's just that some seizures tend to happen during sleep, but they're all really treated the same.
Seizures that occur during wakefulness and sleep are both treated with anticonvulsants. And there's no real difference between the effectiveness of one and another. So we often end up choosing based on side effects.
Now, sedating effect is a very common side effect, and related to sleep, obviously. So medications such as phenobarbital and phenytoin (or Dilantin) are relatively sedating, and we tend to give them at bedtime. There are other medications like topiramate, zonisamide and lamotrigine, so that they can be alerting in some patients, and we give them earlier in the day.
ANNOUNCER: Dosing is also important factor when taking anticonvulsants for sleep-related epilepsy.
CARL BAZIL, MD, PhD: For instance, you might give a higher dose of medication at bedtime so that they're covered during sleep when they usually have their seizures, and so that they don't have so much medicine in their system when they don't need it, when they're awake.