Influence of Therapeutic Phenobarbital and Phenytoin Medication on the Polygraphic Sleep of Patients with Epilepsy

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Abstract
The polygraphic sleep of 40 unmedicated epileptic patients was recorded and compared with polygraphy after adjustment to therapeutic steady states of phenobarbital (PB) and phenytoin (DPH) (as sequential agents in a crossover design with random sequence). With PB, patients fell asleep more rapidly and had fewer movements, movement arousals and arousal awakenings, all of which could be beneficial, especially for patients with generalized epilepsy. Light sleep was increased, and REM [rapid eye movement] sleep decreased. The usual sleep pattern was altered, with maximal deep sleep early and maximal REM sleep late in the night. PB seemed to have maximal effect in the 1st REM cycle. With DPH, sleep onset also came sooner, but light sleep was decreased and deep sleep increased, with no alteration of REM sleep. In contrast to PB, the changes in sleep organization were toward leveling the distribution of deep NREM [nonrapid eye movement] sleep. Maximal alterations were observed in the 3rd REM cycle. With both drugs, there were some differences in the response of generalized as opposed to focal epilepsies, and of awake as opposed to sleep epilepsies. Early REM cycles seemed to be more modifiable by drugs in patients with generalized or awake epilepsies than in patients with focal or sleep epilepsies. Changes observed in photosensitive patients differed from those observed in nonphotosensitive patients with generalized epilepsy, and there was some indication that, in photosensitive subjects, stage 2 was particularly susceptible to change. Group differences were not explained by differences of serum drug levels. The extent of adaptation to the drugs that might be reflected in some of the findings cannot yet be estimated. The data provided by this 1st prospective study on antiepileptic drugs and sleep based on unmedicated patients give rise to new hypotheses and call for further study by longitudinal investigations.