High prevalence of pathological alertness and wakefulness on maintenance of wakefulness test in adults with focal-onset epilepsy

Nov 20, 2021Epilepsy & behavior : E&B

Common excessive alertness and wakefulness in adults with localized epilepsy during wakefulness tests

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Abstract

The mean sleep latency on the maintenance of wakefulness test in 51 adults with focal-onset epilepsy was 21.7 ± 11.9 minutes.

45.1% of participants had an abnormally short sleep latency of less than 19.4 minutes.
15.7% of participants fell asleep in under 8 minutes during the test.
Mean percent sleep time was recorded at 9.3%, indicating low wakefulness maintenance.
The mean score on the Epworth Sleepiness Scale was 8.8, with 39% of participants scoring above 10, indicating elevated subjective sleepiness.
No correlation was found between subjective sleepiness scores and objective measures of sleep latency or percent sleep time.
Participants with focal to bilateral tonic-clonic seizures had significantly shorter sleep latencies compared to those without such a history.

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BACKGROUND: Excessive daytime sleepiness (EDS) is a common complaint in adults with epilepsy (AWE), but objective evaluation is lacking. We used the maintenance of wakefulness test (MWT) to objectively measure the ability of adults with focal-onset epilepsy to maintain wakefulness in soporific conditions.

METHODS: Adults with epilepsy participating in a study investigating the effects of lacosamide on sleep and wakefulness underwent baseline ambulatory polysomnography (PSG)/EEG followed by MWT. Mean sleep latency (MSL) and mean percent sleep time (MST, mean percentage of non-wake EEG scored in 3-sec bins from lights out to sleep onset averaged over the 4 MWT trials) were quantified. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS). Spearman correlation and linear regression assessed relationships between MWT parameters, ESS and relevant sleep and epilepsy-related variables.

RESULTS: Maintenance of wakefulness test MSL in 51 AWE (mean age 43.5 ± 13 years, 69% female, mean BMI 24.6 ± 11.2 kg/m) was 21.7 ± 11.9 min; 45.1% had an abnormally short MSL <19.4 min and 15.7% <8 min. MST was 9.3% [3.3, 19.1]. Mean ESS score was 8.8 ± 5.7; 39% had elevated ESS (>10). No correlation between subjective ESS and objective MSL (p = 0.67) or MST (p = 0.61) was found. MSL was significantly shorter in subjects with focal to bilateral tonic-clonic seizures (FBTCS; 7.9 min [13.6, 22.3]) compared to those without (27.4 min [21.2, 33.6], p = 0.013). Younger subjects had shorter MSL; MSL increased 3.2 min for every 10-year increase in age. 2

CONCLUSION: We found a high prevalence of objective sleepiness/difficulty maintaining wakefulness on the MWT and subjective sleepiness using the ESS in AWE without a correlation between the two. More severe objective sleepiness was found in subjects with a history of FBTCS and younger age. Further research is needed to determine mechanistic underpinnings and optimal measurements of pathological sleepiness in people with epilepsy given the burden of it on quality of life.

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High prevalence of pathological alertness and wakefulness on maintenance of wakefulness test in adults with focal-onset epilepsy

Abstract

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