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Risk of seizures while awake in pure sleep epilepsies

A prospective study

From the Neuroepidemiology Unit (Dr. D’Alessandro and L. Bassein), Department of Neurological Sciences, University of Bologna; Neurological Unit (Dr. Guarino), S. Orsola-Malpighi Hospital, Bologna; and Neurological Department (Dr. Greco), Carpi (Modena), Italy.

Address correspondence and reprint requests to Dr. Roberto D’Alessandro, Unità di Neuroepidemiologia, Dipartimento di Scienze Neurologiche dell’Università di Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy; e-mail: daless.rob{at}iol.it

Objective: To estimate the risk of seizures while awake in pure sleep epilepsies in a prospective study.

Methods: From October 1, 1992, to October 31, 1996, all patients with pure sleep epilepsy presenting at a participating center were enrolled. Children with benign rolandic epilepsy and patients with frontal lobe epilepsy were excluded. Patients were followed for at least 2 up to 6 years. The primary endpoint was the occurrence of a seizure while awake.

Results: The authors enrolled 161 patients (64% male). Age at the time of inclusion ranged from 11 to 83 years (mean 43.2, median 39). Eighty-five percent presented generalized tonic clonic seizures. Both sleep seizures and seizures while awake were absent for 2 years after inclusion in the study in 78% of patients. Eighteen patients presented a seizure while awake. The estimated risk of a seizure while awake during 6 years of follow-up was 13% (95% CI 7 to 18%). Multivariate analysis showed that episodes of sudden withdrawal of therapy and a higher frequency of seizures at inclusion were associated with an increased risk of seizures while awake. The estimated risk of a seizure while awake in patients with none of the above risk factors was 6.5% (95% CI 1.5 to 11.3%) during 6 years of follow-up.

Conclusion: The clinical picture of pure sleep epilepsies is characterized by a preponderance of generalized tonic clonic seizures, low seizure frequency, and a good prognosis. The risk of occurrence of a seizure while awake is low, particularly among patients with rare seizures and good compliance with the therapy.

Received March 3, 2003. Accepted in final form October 6, 2003.

*Members of the Emilia-Romagna Study Group on Clinical and Epidemiological Problems in Neurology are listed in the Appendix on page 257.

Preliminary results were presented at the 48th annual meeting of the American Academy of Neurology; San Francisco.

Correspondence: