Epilepsy with grand mal on awakening and sleep-waking cycle

Awakening epilepsy (AE) is an age related syndrome of idiopathic generalize d epilepsy (IGE) characterized by generalized tonic clonic seizures (GTCS) occurring predominantly on awakening (independent of the time of day) or at leisure time (almost at evening). The GTCS can be the only symptom or they can be combined with the other subsyndromes of IGE in childhood or adolesc ence: The EEG shows the characteristics of IGE (generalized spike wave freq uent, focal abnormalities rare, photosensitivity increased). The common den ominator of external seizures precipitating influences is lack of sleep. Th e sleep habits of patients with AE who could roughly be characterized as la te sleepers and late risers may dispose them to a chronic sleep deficit. Po lygraphic studies indicated that their sleep is more unstable and subject t o external influences. Microstructural sleep analysis confirms the presence of a disturbance of sleep stability in patients with IGE. Furthermore it c learly shows that in the prototype of AE, the juvenile myoclonic epilepsy, the epileptiform activity during non-REM sleep is correlated with the arous al phase of the so called cyclic alternating pattern indicating that even i n the smallest sleep-waking oscillations awakening is the most sensitive pa rt. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.