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Study Objectives: <p>Seizures are rare in rapid eye movement (REM) sleep. However, seizures sometimes occur in REM sleep, and a small number of focal epilepsy patients display their maximum rate of interictal epileptiform discharges in REM sleep. We sought to systematically identify and characterize seizures in REM sleep.</p> Methods: <p>We reviewed all admissions to the epilepsy monitoring unit at the Winnipeg Health Sciences Center over 12 months in 2014–2015. American Academy of Sleep Medicine sleep-stage scoring was initially applied in the standard 30-second epochs. Then, to capture sudden changes in sleep–wake state on shorter timescales that are associated with seizure formation and propagation, we rescored ictal and peri-ictal electroencephalography epochs every 1 second. Patients found to have seizures in REM sleep were subject to chart review spanning 3 years pre- and postadmission.</p> Results: <p>REM sleep seizures occurred in 3 of 63 patients admitted to the epilepsy monitoring unit. Notably, 1 patient exhibited continuous epileptiform activity, consistent with focal nonconvulsive electrographic status epilepticus, throughout REM sleep cycles for each night of her admission. Otherwise, discrete REM sleep seizures constituted a small fraction of the other patients’ total seizures (range 5.0–8.3%), occurred shortly after REM sleep onset from stage N2 sleep, and were manifest as minor epileptic arousals.</p> Conclusions: <p>Our results confirm that REM sleep seizures are rare, while highlighting outliers who widen the known spectrum of heterogeneous sleep effects on seizures/epilepsy. We also report, to our knowledge, the first case of paradoxical status epilepticus in REM sleep.</p> Citation: <p>McLeod GA, Szelemej PA, Toutant D, McKenzie MB, Ng MC. Dreams interrupted: characteristics of REM sleep–associated seizures and status epilepticus. <i>J Clin Sleep Med.</i> 2025;21(1):23–32.</p>

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Dreams interrupted: characteristics of REM sleep–associated seizures and status epilepticus

  • 期刊论文

  • 发表日期：

    2025年1月1日

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  • Graham A. McLeod,
  • Paul A. Szelemej,
  • Darion Toutant,
  • Marna B. McKenzie,
  • Marcus C. Ng

摘要

Study Objectives:

Seizures are rare in rapid eye movement (REM) sleep. However, seizures sometimes occur in REM sleep, and a small number of focal epilepsy patients display their maximum rate of interictal epileptiform discharges in REM sleep. We sought to systematically identify and characterize seizures in REM sleep.

Methods:

We reviewed all admissions to the epilepsy monitoring unit at the Winnipeg Health Sciences Center over 12 months in 2014–2015. American Academy of Sleep Medicine sleep-stage scoring was initially applied in the standard 30-second epochs. Then, to capture sudden changes in sleep–wake state on shorter timescales that are associated with seizure formation and propagation, we rescored ictal and peri-ictal electroencephalography epochs every 1 second. Patients found to have seizures in REM sleep were subject to chart review spanning 3 years pre- and postadmission.

Results:

REM sleep seizures occurred in 3 of 63 patients admitted to the epilepsy monitoring unit. Notably, 1 patient exhibited continuous epileptiform activity, consistent with focal nonconvulsive electrographic status epilepticus, throughout REM sleep cycles for each night of her admission. Otherwise, discrete REM sleep seizures constituted a small fraction of the other patients’ total seizures (range 5.0–8.3%), occurred shortly after REM sleep onset from stage N2 sleep, and were manifest as minor epileptic arousals.

Conclusions:

Our results confirm that REM sleep seizures are rare, while highlighting outliers who widen the known spectrum of heterogeneous sleep effects on seizures/epilepsy. We also report, to our knowledge, the first case of paradoxical status epilepticus in REM sleep.

Citation:

McLeod GA, Szelemej PA, Toutant D, McKenzie MB, Ng MC. Dreams interrupted: characteristics of REM sleep–associated seizures and status epilepticus. J Clin Sleep Med. 2025;21(1):23–32.