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Seizures, Epilepsy and Sleep Disorders
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INTRODUCTION
Seizures, abnormal sleep patterns and syncope, can be difficult to distinguish apart. The last of these, occurring in the absence of heart failure, is incredibly rare but the first 2 are quite distinguishable if observed. A [24-hour] video recording can be useful to capture suspected episodes of sleep and seizures when they are not overt.
SLEEP DISORDERS
Sleep disorders in humans can been divided into narcolepsy [with cataplexy], narcolepsy without cataplexy and idiopathic hypersomnia . Narcolepsy occurs in 0.02-0.15% of the population and patients typically demonstrate excessive diurnal sleep, flaccid paralysis with somatic areflexia [cataplexy], sleep paralysis, sleep-onset hallucinations and nocturnal disrupted sleep. Strict EEG and EOG criteria, including the early onset of rapid eye movement (REM) at the beginning instead of the middle of a sleep cycle, are in place for confirming the diagnosis and distinguishing narcolepsy from narcolepsy without cataplexy and from idiopathic hypersomnia. A familial form occurs in dogs and humans and in the latter it is associated with the genetic allele HLA-DQβ1-0602. Narcolepsy without cataplexy shares the same electrophysiological abnormalities and associated signs but there is no demonstrable cataplexy. Purely excessive daytime sleep attacks [also referred to as “unwanted siestas”] occur in idiopathic hypersomnia.
Over the past few years great strides have been made in unravelling the pathophysiology of narcolepsy in humans, mice and dogs. Two novel neuropeptides, hypocretins [orexins] 1 and 2, were found to be specifically expressed in certain hypothalamic neurons and defective hypocretin-2 signalling was related to both familial and sporadic narcolepsy. A mutation in the hypocretin receptor-2 gene was present in dogs with familial narcolepsy although they had normal levels of hypocretins in their CSF and hypothalamus. Neurotransmission through hypocretin-1 was likely to be intact indicating that defective hypocretin-2 function is more important in producing narcolepsy in that model. In contrast, dogs with sporadic narcolepsy had no expressed hypocretins in the CSF or brain tissue. [...]
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