Article

The purpose of this review was to examine the possible pathophysiological
links between epilepsy, cognition, sleep macro- and microstructure, and sleep
disorders to highlight the contributions and interactions of sleep and epilepsy
on cognitive functioning in children with epilepsy. METHOD: PubMed was used as
the medical database source. No language restriction was placed on the literature
searches, and citations of relevant studies in the paediatric age range (0-18 y)
were checked. Studies including a mixed population but with a high percentage of
children were also considered. RESULTS: The searches identified 223 studies. One
reviewer scanned these to eliminate obviously irrelevant studies. Three reviewers
scanned the remaining 128 studies and their relevant citations. The review showed
that several factors could account for the learning impairment in children with
epilepsy: aetiology, electroencephalographic (EEG) discharges, and persistence
and circadian distribution of seizures, etc. EEG discharges may affect cognition
and sleep, even in the absence of clinical or subclinical seizures. The sleep
deprivation and/or sleep disruption affect the neurophysiological and
neurochemical mechanisms important for the memory-learning process, but also
influence the expression of EEG discharges and seizures. Learning and memory
consolidation can take place over extended periods, and sleep has been
demonstrated to play a fundamental role in these processes through neuroplastic
remodelling of neural networks. Epilepsy and EEG paroxysms may affect sleep
structure, interfering with these physiological functions. INTERPRETATION:
Improvement in the long-term cognitive-behavioural prognosis of children with
epilepsy requires both good sleep quality and good seizure control. The
antiepileptic drug of choice should be the one that interferes least with sleep
structure and has the best effect on sleep architecture--thus normalizing sleep
instability, especially during non-rapid eye movement sleep.

Langue : ANGLAIS