Wednesday, May 5, 2010

A personal account of seizures and sleep apnea

Last October I wrote a post on seizures and sleep apnea. In the post I wrote that there seems to be a connection between the two. Recently, I received a very informative and personal account of someone with seizures and sleep apnea.

Here is the comment…

I can relate to your confusion. I first started having grand mal seizures in my sleep when I was 32, their frequency increased to approx. once a month (with a max of 2 in one week). My wife noticed that I gasped for air in my sleep, and sometimes there was a noticeable gap in my breathing in my sleep. Despite the fact that all of my seizures were in my sleep and my wife noticed breathing problems in my sleep, I saw 4 neurologists in 2 years and all of them dismissed apnea as an issue (it took me two years, two years of hell on epilepsy medication that exacerbates apnea, to find a neurologist that would actually give me a sleep study as the others thought that I "was not fat enough" for apnea). Each of them claimed that there was no proof of a relationship. Unfortunately, they used the textbook definition of proof (which is not relevant in neurology - i.e. most of the conditions in neurology are not amenable to randomized-controlled experiments). They all ignored the fact that since the 1980s there has been substantial evidence that there is a pathogenic link (unfortunately since the late 90s work in this area died off, it is now a fashionable issue once again, mainly thanks to Beth Malow at Vanderbilt). If any neurologist uses the word "proof" in their diagnoses, get as far away from them as possible. Stick to the ones who refer to "evidence."

There are a lot of papers out there that study the relationship between seizures and apnea, here are a few of the key results:

"Epilepsy and sleep apnea syndrome," Neurology, 1994, vol. 44, no11, pp. 2060-2064, "Obstructive sleep apnea is common in medically refractory epilepsy patients," Neurology, 2000, vol. 55, no7, pp. 1002-1007 (where one third of patients with epilepsy were found to have apnea, 50% for males). In 2006 a researcher went as far as to say: "we did observe a significant trend toward improvement in seizure frequency among patients who received CPAP - a result that rivals that of an antiepileptic drug," principal investigator Beth Ann Malow, MD, from Vanderbilt University. “Three of the patients became seizure free and a fourth patient had a greater than 95% reduction in seizure frequency following only the initiation of therapy for the sleep apnoea.”Vaughn et al., 1996 .

I really love comments like this that bring in their personal experiences and their thoughtful insights into the subject of sleep apnea.

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