August 15, 2008

Addressing apnea may improve epilepsy seizure control: study

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Beth Malow, M.D.

Addressing apnea may improve epilepsy seizure control: study

A study by Beth Malow, M.D., professor of Neurology and director of the Vanderbilt Sleep Disorders Center, indicates that treating sleep apnea in patients with epilepsy may improve seizure control.

The pilot trial identified patients with medically refractory epilepsy and coexisting obstructive sleep apnea and randomized the subjects into two groups.

One group was treated with continuous positive airway pressure (CPAP), and the other group was treated with placebo, or sham, CPAP.

Of those in the therapeutic group, 28 percent had a 50 percent or greater reduction in seizures as compared to only 15 percent of those in the control group.

Four subjects in the therapeutic group became seizure free as compared to only one subject in the sham group.

“The exciting concept that comes from this trial is that treating a sleep disorder is an opportunity to improve overall health,” Malow said.

“It's a model where treating a sleep disorder could impact favorably on underlying conditions like heart disease, depression, diabetes and ADHD, for example. It opens up the window to helping coexisting problems.”

The study, funded by the National Institute of Neurological Disorders and Stroke and the Vanderbilt Institute for Clinical and Translational Research, also addressed critical design issues that will make a future, larger study more successful.

Malow found that patient histories and questionnaires were effective at identifying individuals with apnea and that one sleep study is sufficient to confirm this.

The sham CPAP was an effective placebo, and both the sham and therapeutic CPAP groups tolerated the devices equally well.

Malow plans to go forward with a more extensive trial, enrolling more test subjects at more sites to get statistically significant results.

She also hopes to discover the link between sleep apnea and epilepsy.

“We understand the basic mechanisms underlying the two disorders, but there is no clear reason why apnea causes seizures,” Malow said.

The study, titled “Treating obstructive sleep apnea in adults with epilepsy,” will be published in the Aug. 19 issue of Neurology.