Abstract
We present a case report of a 23-year old male with newly diagnosed epilepsy manifested with generalized tonic seizures. Levetiracetam (LEV) was started and the patient was seizure free. The patient demonstrated intermediate chronotype determined by the Morningness-Eveningness Questionnaire (MEQ). There was no epileptiform activity on electroencephalography (EEG) and polysomnography (PSG), sleep architecture disturbances (PSG) or daytime sleepiness (Epworth sleepiness score, Multiple sleep latency test) at the onset and after 3 months of LEV therapy. The melatonin serum levels after 3 months of LEV treatment were 22.00 pg/ml at 3 a.m. and 23.60 pg/ml at 8 a.m. - there was no normal night peak concentration. This abnormality may be associated with a later night peak melatonin concentration, the treatment with levetiracetam being a possible explanation. We consider the presented clinical case of special interest because of the combination of absence of normal night peak melatonin concentration, normal sleep parameters and non-extremely presented chronotype. We suggest that such patients could benefit from add-on therapy with melatonin.
Highlights
Sleep disorders and daytime sleepiness are common in patients with epilepsy [1,2,3]
We present a case report of a 23-year old male with newly diagnosed epilepsy manifested with generalized tonic seizures
The melatonin serum levels after 3 months of LEV treatment were 22.00 pg/ml at 3 a.m. and 23.60 pg/ml at 8 a.m. - there was no normal night peak concentration. This abnormality may be associated with a later night peak melatonin concentration, the treatment with levetiracetam being a possible explanation
Summary
Sleep disorders and daytime sleepiness are common in patients with epilepsy [1,2,3]. The effect of epilepsy and sleep is reciprocal and it is controversial, whether the impaired sleep worsens seizure control, or the poor seizure control worsens sleep quality. It has been reported that sleep facilitates seizure activity in epilepsy [4]. It is conceivable that seizure timing influences the timing of daily activities, sleeping, and wakefulness (i.e., chronotype) [5]. 2. Case report We present a case of a 23-year-old male with epilepsy onset with a generalized tonic seizure when he was 19 years old. Case report We present a case of a 23-year-old male with epilepsy onset with a generalized tonic seizure when he was 19 years old He has had 3 more seizures with the same characteristics. After the fourth seizure the patient attended the Clinic of Neurology at the University Hospital in Plovdiv. All study procedures were performed after approval of the Local Ethics Commission at the Medical University, Plovdiv, Bulgaria.
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