1156 Evaluating Sleep and Associated Comorbidities in 5-18-Year-Olds with Pharmaco-Responsive Non-Lesional Epilepsies: A Prospective Observational Study

Abstract Introduction Pharmaco-responsive non-lesional epilepsies (normal MRI Brain epilepsy protocol) constitute approximately 50% of childhood and adolescent epilepsies represented by primary generalised epilepsies and focal epilepsies with centrotemporal/occipital/frontal/temporal focus. Studies have shown sleep as a modifier of epilepsy and associated cognition and behaviour, more so in drug refractory epilepsies and epileptic encephalopathies. This literature is scanty in pharmaco-responsive non-lesional epilepsies. The current study characterised sleep architecture and evaluated cognition, behaviour and quality of life, pre and post standard-of-care for those with sleep disorders in 5-18-year-olds with pharmaco-responsive non-lesional epilepsies. Methods Cases were enrolled at a north Indian tertiary care teaching hospital if they were seizure free for at least 12 months and had a baseline intelligence quotient (IQ)>70. All the cases underwent detailed clinical evaluation and overnight polysomnography (PSG). Those with sleep disorders received standard-of-care and were revaluated with overnight PSG after 6 months. They underwent Wechsler’s intelligence scale for children-IV (WISC-IV), Child Behaviour Checklist (CBCL), and Peds QL (Pediatric Quality of life generic scales) evaluation pre and post standard-of-care. Results Forty-nine cases (mean age 11.5 ± 2.5 years; 53.06% male; 26/49 generalized, 23/49 focal epilepsy) were enrolled. Commonest generalised and focal epilepsies were generalised-tonic- clonic-seizures alone and temporal lobe epilepsy respectively. Sleep disorders were identified in 59.18% (29/49, 15 generalised and 14 focal), most commonly periodic limb movement disorder (48.98%) and obstructive sleep apnea (30.61%). Behavioural comorbidities were seen in 24.5% (10/49, majority attention deficit hyperactivity disorder, all had sleep disorders) and specific learning disability was seen in 20.4% (10/49, 9 had sleep disorders). After six months of standard of care in those with sleep disorders and associated comorbidities (n=29), - Overnight PSG showed improved sleep efficiency (p=0.031) and REM sleep (p=0.004), - WISC-IV and CBCL showed improved full-scale IQ (p=0) and total scores (p=0.04) respectively, and - Peds QL showed improvement in physical, emotional, social and school functioning (p<=0.01). Conclusion Despite adequate seizure control, sleep disorders are common in in these epilepsies and are associated with other behavioural and scholastic comorbidities. Managing sleep and other comorbidities leads to improvement in sleep, associated comorbidities, and overall quality of life. Support (if any)