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    • About a third of epileptic patients present

    2018-11-13

    About a third of epileptic patients present seizures during sleep [51]. Sleep can activate the occurrence of seizures and electroencephalogram (EEG) abnormalities [52]. Van Golde refers that during NREM (non-rapid eye movement) sleep discharges are facilitated (most likely for the synchronized pattern of EEG), while a suppression occurs at REM (rapid eye movement) sleep, making it difficult the propagation of the discharges secondary to a desynchronized pattern [53,54]. The effect of sleep in some epileptic syndromes is well known, as in benign epilepsy with centro-temporal spikes (BECTS). It is also recognized that sleep deprivation can be responsible for epileptiform activity; however, it still exists the discussion if it occurs secondary to sleep induction or neuronal excitability [53,54]. Increase of awakenings, daytime sleepiness, reduced total sleep and the greatest need for the presence of parents at bedtime are important characteristics of children with epilepsy, from the behavioral point of view [55,56]. Moreover, it is also known that sleep patterns and behavior changes may come to affect both children and parents [57]. Anxiety and fear that the child have a night crisis is a plausible sodium channel to explain the worsening of sleep quality [58]. According to Parisi et al. this is reflected in the fact that children with epilepsy present better cognitive and behavioral prognosis when they have an adequate quality of sleep and seizure control [59]. Another important issue is to evaluate possible differences between the sleep of patients with “primary” ADHD and patients with ADHD as epilepsy comorbidity. The second key issue is the influence of methylphenidate on sleep quality of patients with epilepsy and ADHD. In a recent study [60], it was demonstrated by means of actigraph, differences among ADHD patients using methylphenidate and those using placebo. The methylphenidate users showed a significant decrease in the analysis of average activity and a significant reduction in total sleep time compared to placebo. This fact leads us to another question: despite the effectiveness of methylphenidate, with improvement in approximately 70% of patients [61], and few side effects, a major impasse in daily clinical practice is the decision to treat epileptic patients or those with epileptiform EEG abnormalities [62]. Thus, the uncertainty of decreased threshold for seizures can interfere with medical management, depriving the patient receiving the drug which has the greatest efficacy on the symptoms it presents.
    Conflicts of interest
    Introduction Shift work is work done by an individual whose normal hours of work are outside the traditional 9–5p.m. work day [1]. It can involve evening or night shifts, early morning shifts, and rotating shifts. It is common in many professions, especially those involving essential services, and today shift workers represent between 15% and 25% of the global workforce [1–3]. The search for quality sleep has always been a challenge for shift workers, because they must reverse their biological rhythms and conduct activities at nighttime, a time when there is a greater propensity for drowsiness. Furthermore, daytime rest subjects these workers to greater alertness and light [5,6]. Therefore, they are often chronically sleep deprived [7,8]. It is known, for example, that sleep deprivation is associated with accidents at work [9], metabolic diseases [10], and cardiovascular diseases [11,12]. Recent research has also observed an association between sleep loss and viral infections [13–15]. It is not fully understood how sleep contributes to efficient immunological memory, interferes with the immune system, or predisposes the body to infections [16]. The quiescent period of sleep can serve, for example, to renew functions related to wakefulness and processes affecting the immunological response to infections [17,18]. The deterioration of sleep in modern society, as observed among shift workers, in turn, is associated with an increasing susceptibility to the development of infectious diseases such as flu [13,15], airway infections [14] and failure to control immunization against certain diseases [19]. So, sleep debt/ sleep deficit can have a major economic impact on public health policies and probably emerge as an important regulator of the immune system [16].