Epilepsy with grand mal on awakening and sleep-waking cycle.

Awakening epilepsy (AE) is an age related syndrome of idiopathic generalized epilepsy (IGE) characterized by generalized tonic clonic seizures (GTCS) occurring predominantly on awakening (independent of the time of day) or at leisure time (almost at evening). The GTCS can be the only symptom or they can be combined with the other subsyndromes of IGE in childhood or adolescence. The EEG shows the characteristics of IGE (generalized spike wave frequent, foca1 abnormalities rare, photosensitivity increased). The common denominator of external seizures precipitating influences is lack of sleep. The sleep habits of patients with AE who could roughly be characterized as late sleepers and late risers may dispose them to a chronic sleep deficit. Polygraphic studies indicated that their sleep is more unstable and subject to external influences. Microstructural sleep analysis confirms the presence of a disturbance of sleep stability in patients with IGE. Furthermore, it clearly shows that in the prototype of AE, the juvenile myoclonic epilepsy, the epileptiform activity during non-REM sleep is correlated with the arousal phase of the so called cyclic alternating pattern indicating that even in the smallest sleep-waking oscillations awakening is the most sensitive part.