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Sleep deprivation increases cortical excitability in epilepsy

Syndrome-specific effects

From the Department of Neurology (R.A.B.B., J.M.C., M.N., S.F.B., R.A.L.M.), Austin Health, Heidelberg, and Epilepsy Research Institute (R.A.B.B., S.F.B.), Heidelberg West, and Department of Medicine (S.F.B., R.A.L.M.), University of Melbourne, Victoria, Australia.

Address correspondence and reprint requests to Dr. R. Macdonell, Department of Neurology, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia; e-mail: Richard.Macdonell{at}austin.org.au

Objective: To use transcranial magnetic stimulation (TMS) to investigate the hypothesis that sleep deprivation increases cortical excitability in people with epilepsy.

Methods: We performed paired pulse TMS stimulation, using a number of interstimulus intervals (ISIs) on each hemisphere of 30 patients with untreated newly diagnosed epilepsy (15 idiopathic generalized epilepsy [IGE] and 15 focal epilepsy) and on the dominant hemisphere of 13 healthy control subjects, before and after sleep deprivation.

Results: Both hemispheres in patients with IGE and the hemisphere ipsilateral to the EEG seizure focus in those with focal epilepsy showed an increase in cortical excitability following sleep deprivation at a number of ISIs. This change in excitability was most prominent in the patients with IGE. Although there were minor changes after sleep deprivation in control subjects and the contralateral hemisphere in the focal epilepsy group seen at the 250-millisecond ISI, it was less than in the other groups.

Conclusions: Sleep deprivation increases cortical excitability in epilepsy; the pattern of change is syndrome dependent.

Disclosure: The authors report no conflicts of interest.

Received February 21, 2006. Accepted in final form May 10, 2006.

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