Epilepsy, sleep and neuropeptides. Future directions

Abstract Introduction Epilepsy and sleep are intimately linked; patients with epilepsy frequently present sleep disorders and alterations in sleep quality and architecture. This, in turn, leads to greater prevalence of psychiatric and cognitive comorbidities and poorer quality of life. Development Sleep is a physiological process regulated by the circadian rhythm. The sleep–wake cycle occurs as a result of the reciprocal activity of numerous regions and circuits in the brain, via neuromediators. The different stages of sleep also influence the propagation of interictal epileptiform discharges and epileptic seizures. Non-rapid eye movement sleep facilitates their propagation, whereas rapid eye movement sleep suppresses it. This connection is made even more evident by the existence of epileptic syndromes that occur only or mainly during specific stages of the sleep–wake cycle. Antiepileptic drugs also influence this cycle. Better sleep quality may have positive effects on seizure control, and vice versa. Conclusions New therapeutic targets involve the sleep–wake cycle, with orexin receptor antagonists having been proposed as a potential antiepileptic treatment. However, more research and controlled clinical trials are needed to corroborate these findings.