Sleep modulation of epileptic activity in mesial and neocortical temporal lobe epilepsy: a study with depth and subdural electrodes.

This study characterizes the spatial-temporal distribution of epileptic activity in mesial and neocortical temporal lobe epilepsy (TLE) assessed by subdural and depth electrodes during sleep. We determined in 13 patients the frequency, lateralization, and localization of interictal epileptic discharges (IEDs). As compared to the waking state, IEDs increased in light sleep (196%, p < 0.05) and in deep sleep (601%, p < 0.05) but did not change significantly in REM sleep (-8.33%, p = 0.94). From 11 patients with unilateral TLE, in all cases, IEDs lateralized to the seizure onset side during REM sleep and the waking state. In mesial TLE, IEDs tended to shift in an anterior-posterior axis and remained always localized in the amygdalo-hippocampal complex. By contrast, in neocortical TLE, the maximal activity moved in a mesial-lateral axis between neocortical and mesial structures. Twenty-six seizures were registered in 7 patients, 22 of which occurred in light sleep and 4 in wakefulness, but none occurred in deep or REM sleep.