NOCTURNAL SLEEP AND DAYTIME SOMNOLENCE IN UNTREATED PATIENTS WITH TEMPORAL-LOBE EPILEPSY - CHANGES AFTER TREATMENT WITH CONTROLLED-RELEASE CARBAMAZEPINE

Purpose: To define sleep disturbances in patients with temporal lobe e pilepsy (TLE) and explore the association between carbamazepine (CBZ) therapy, sleep, and daytime somnolence. Methods: We recorded nocturnal polysomnography and measured subjective and objective daytime somnole nce in a group of newly diagnosed TLE patients, who had no evidence of anatomic brain lesion on neuroimaging and had never been treated befo re. Recordings were performed at baseline, after the initial administr ation of 400 mg CBZ-controlled release (CR) and after 1 month of treat ment (400 mg twice daily b.i.d.). The findings were compared with thos e of a group of young healthy volunteers, both at baseline and after t he first administration of CBZ. The chronic effect of CBZ-CR treatment was evaluated only in TLE patients. Results: At baseline, nocturnal s leep patterns of TLE patients did not show marked alterations when the influence of seizures, cerebral lesions, and drugs had been ruled out . In both the TLE and the control groups, initiation of CBZ therapy pr ovoked a reduction and a fragmentation of rapid eye movement (REM) sle ep and an increase in the number of sleep stage shifts. In the TLE gro up, these effects were almost completely reversed after 1 month of tre atment, and no significant difference was noted between baseline condi tion and long-term follow-up. With regard to daytime sleepiness, initi al administration of the drug caused an increase in objective sleepine ss only in the control group. Subjective sleepiness was higher in the control group than in the TLE group but was not modified by the drug. Conclusions: We conclude that CBZ-CR has negative effects on REM sleep during initial administration but chronic treatment does not signific antly modify nocturnal sleep or daytime somnolence.