Abstracts

Rationale: The onset of seizures in the immediate awake state after nocturnal sleep or naps is well documented in juvenile myoclonic epilepsy, we wanted to analyze the timeline from waking up and evaluate the highest risk for seizure onset within different time frames in relation to wakefulness after sleep. 

Methods: A sample of 35 patients with juvenile myoclonic epilepsy were selected from a pediatric epilepsy clinic in south Texas from an academic affiliated hospital, the patients were from age 13 to 21 years old; we analyzed the clinical data on seizure onset in regards to the time being awake after sleep (TAAS), we included the nocturnal sleep and the naps in the sample in brackets of 15 minutes up to 2 hours of wakefulness, we included any type seizure with loss of consciousness (GSLOC) in the study. Questionnaires for clinical seizures were given to families, variables of usual sleep schedules and sleep deprivation as well as those for usual naps and unusual daytime sleep were included. Additional information including the duration and strength of the seizures as well as myoclonic activity were also noted. The variable in regard to driving within the time frame was also included. Compliance of medication taking was monitored by anti-epileptic medication logs and blood levels. 

Results: The median age was 17 years, the total sleep time (TST) for the nocturnal sleep was 7.8 hours, the TST for the naps was 1.3 hours. Compliance with anti-epileptic treatment was in all cases appropriate. The majority of the seizures occurred in the first 90 minutes after sleep, there was no significant association of myoclonic activity with the recurrence of seizures. The majority of cases did not drive within 2 hours of waking up, only one case of a seizure while driving was documented and that occurred within the first 45 minutes after being awake. The presence of sleep deprivation and unusual naps was strongly associated with seizures with statistical significance (p > 0.01). 

Conclusions: The timing of the awake after sleep schedule in the patients with juvenile myoclonic epilepsy is extremely important, that happens to be the most important factor to predict potential seizures at least within the first 2 hours after wakefulness, and that risk is exponentially increased if there is the association of sleep deprivation or unusual naps before the convulsions, our view is that an age driving patient should avoid driving within that time frame after waking up to prevent potential accidents even in fully compliant anti-epileptic medication takers. Further studies with a larger population are needed. 

Funding: None