Two distinct classifications of adult epilepsies: by time of seizures and by sensitivity of the interictal paroxysmal activities to sleep and waking

Abstract

Two hundred and thirty-six adult epileptic outpatients were classified twice: firstly according to the time of seizures reported by the patient or his family in diurnal, nocturnal, awaking and diffuse epilepsies (Es) and secondly according to the sensitivity to sleep or waking of the interictal paroxysmal activities (PA) observed during a polysomnographic night session with a sleep PA increase, with a waking PA increase, with PA indifferent to sleep and waking or with few or no PA. The stability of the sensitivity of the PA to sleep and waking was 84%. Patients with diurnal epilepsy have more frequently myoclonic attacks and a lower seizure frequency. Patients with a sleep PA increase have less frequently generalized motor seizures, more frequently partial complex seizures, a higher seizure frequency, higher total night PA density and more frequently the appearance of new PA during sleep. Patients with a waking PA increase had more frequently massive myoclonus, rarely the appearane of new PA during sleep and a high total night PA density. There is no significant relationship between the two classifications. Neither classification succeeds in discriminating the electro-clinical type of the epilepsies.