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Epilepsy and sleep disorders diagnostic test: Dr. Rodolfo César Callejas explains the relationship between them

March 1, 2022

Neurovirtual: Tell us about your professional and academic trajectory. How was your specialization in epilepsy?

Dr. Callejas: Upon graduating, Neuroscience is something that has always been of interest to me. Perhaps the only decision I had to make was choosing between basic science and clinical. However, those aspects were always there: sleep and epilepsy. I started working with an animal model that evaluated both disorders. During social work studies, I had the opportunity to work in a neurophysiology clinic center. At that moment, I decided to go with the clinical part, assisting and working with people.

Meaning that the same neurology training led me to clinical neurophysiology. And thanks to the guidance of my mentors, I managed to get closer to the world of epilepsy. Universities have also always supported us with scholarship access, and the possibility to go abroad for training, not only in neurophysiology but also in video encephalograms.

We had the opportunity to spend some time at the Cleveland Clinic Epilepsy Center (USA). We were also in Germany, where we met the International group known as League Against Epilepsy, which gave us access to their courses offered in Latin America, specifically in Brazil, and also Europe, mainly in Italy.

So, the community presented us with a wide range of opportunities to develop epilepsy and sleep, almost naturally.

Neurovirtual: What are the relationships that can be set between epilepsy and sleep disorders?

Dr. Callejas: If we consider that epilepsy is a disease that will be with us throughout our lives, and more than a third of our lives which is spent sleeping, then it is understood that this relationship is intrinsic. This irregular electrical activity in our brain often disrupts sleep in regular phases.

At the clinic on a daily basis, it is very common to find people with epilepsy who also suffer from sleep disorders. The existence of sleep disorders unrelated to epilepsy is also very high. It is estimated that in Latin America, 30% of the population suffers from sleep disorders.

Therefore, the probability of being diagnosed with epilepsy and having a sleep disorder is also high. What we are doing now across forums, conferences, courses, and marketing is emphasizing that we have to intentionally look for sleep disorders in those already diagnosed with epilepsy.

Neurovirtual: Nocturnal epilepsy usually occurs during childhood or adolescence. What are the main long-term effects for those who suffer from this disorder?

Dr. Callejas: I want to emphasize, that this type of epilepsy, in addition to being common at those ages, is also frequent in adults and the elderly. Maybe the difference is, that depending on the stage of life, manifestation can change.

The main issue with school performance in children, is that if they do not receive relative care in ensuring adequate sleep, they tend to have a lower employability rate in the future, which research shows in different countries as an issue.  We need to be certain that children’s education allows them to chance to have productive adult lives.

Neurovirtual: What are the main difficulties faced by patients with nocturnal epilepsy?

Dr. Callejas: First, it is the lack of diagnostics. Diurnal manifestations, which appear during the day, are usually attributed to some other cause. This can be due to  fatigue, stress, or anxiety, never considering that it could be a diagnosis of epilepsy. In fact, it could be epilepsy itself that is causing sleep problems. As I said, what we need to take into consideration, is the intentional search for sleep disorders in those who already have a diagnosis of epilepsy.

Neurovirtual: Could you tell us which difficulties you face in finding a diagnosis?

Dr. Callejas: What worries us the most in this environment that I am currently working on in my country, Mexico, is the access to health resources. This is something that we have as an international community, but here in Mexico, we are still trying to close the diagnostic gap, not just the treatment gap. I could summarize like this: even though we are trying to advance, access to diagnostic studies is still difficult. We are,  with the support of medical organizations and academies, dedicated to making these studies accessible to the general population.

Neurovirtual: When we talk about patients who have epileptic seizures, is there a different protocol for performing these sleep tests? Are there any special precautions that should be taken into account?

Dr. Callejas: What interests us is that people understand how important it is to do this test. When we discuss this, I particularly enjoy speaking with epileptic patients and families about test details such as sensitivity and specificity.

It’s something we would normally reserve just for healthcare personnel, but sharing this information with the person who has epilepsy and his family makes them understand the importance of doing comprehensive studies.

When we want to assess sleep, it has to be an all-night test, so that we can, even for diagnostic purposes, although it may seem counterintuitive, identify a crisis during the exam. This turns out to be ideal for the diagnosis of nocturnal epilepsy. Or we can record the fragmentation in sleep phases for a night, which ends up diagnosing sleep problems associated with epilepsy. More important than talking about the necessary measures and safety protocols applied during the study, which is highly recommended, both for the patient and his family, is to explain the importance of carrying out a complete exam.

Neurovirtual: Can sleep epilepsy go along with psychological disorders such as anxiety or depression?

Dr. Callejas: The short answer is yes. And it is because the anatomical place is the same, and frequencies in the field that use the temporal lobe are the most frequent. And, of course, in those structures are the amygdala, the hippocampus… which has to do with memory, anxiety, and mood.

Therefore, it is common for people diagnosed with epilepsy to have a higher risk of developing anxiety or depression. For those who have a sleep disorder, the risk of having anxiety and depression is double.

In cases where these two coexist – sleep disorders and epilepsy – the probability of having anxiety and depression is very high. And what matters is, once again, early identification. That is, from the first appointment, and the moment they come back again, we should always be looking for symptoms of anxiety and depression in the patient.  There are now very short questionnaires, about 2 minutes long, in which we can identify anxiety or depression in people with epilepsy.

Neurovirtual: There has been a huge increase in the number of diagnoses of sleep disorders due to the pandemic environment in which we find ourselves. Do you also see an increase in nocturnal epilepsy?

Dr. Callejas: In fact, we are already seeing studies that have been carried out, through validated questionnaires. At least here in Mexico, we know that, due to the pandemic, the statistics of mood disorders rose from 27% to 60%. And these numbers are reflected regardless of the diagnosis. In other words, we are seeing the same number, the same increase in those who already have a diagnosis of epilepsy. And often, in the daily appointments, we are identifying people who came in due to a sleep disorder triggered by anxiety or depression, but who had underlying non-motor epilepsy that had not been diagnosed, for example.

Neurovirtual: Did working with the Neurovirtual team facilitate the diagnosis?

Dr. Callejas: The answer is yes. It is because it allows us to do a video electroencephalogram with polysomnography at the same time. We have the opportunity in 9 hours, to see the electrical activity of a person’s brain while they sleep. This not only helps us to see stages of sleep that are so important in the assessment of disorders but also allows us to increase the sensitivity of the same encephalogram by up to 94%.

Neurovirtual: Could you tell us about your experience so far using the Neurovirtual equipment?

Dr. Callejas: Quite well, I would say. Our technicians are also very comfortable using Neurovirtual equipment. They are very intuitive, very friendly, and perhaps the key point is the 24/7 support, which often makes it possible for doctors to step away for a moment and solve some problem that the technician may have during a study in the middle of the night, making the day to day a lot easier.

Neurovirtual: Would you recommend the Neurovirtual brand?

Dr. Callejas: Yes, I would recommend the Neurovirtual brand. It offered us, not only the possibility of training our employees, but also facilitating their daily work. Precisely, as I mentioned before, making studies accessible at the end of the day, and having a differential diagnosis in a single moment, in a single study, in a single night. “Are we experiencing a sleep disorder? Are we facing a diagnosis of epilepsy? Maybe it is both?” It became much easier to do both assessments in a single test.

Neurovirtual: In your interview with Business Leader, in 2020, you commented on the project to include Transcranial Electrical Stimulation Therapy (tDCS) in the Neuro Sleep Clinic. Would it be a beneficial alternative for epileptic patients during sleep?

Dr. Callejas: Yes. There are currently areas of investigation on how to improve, including sleep, in other neurodegenerative diseases using Direct Transcranial Stimulation. There are also many lines of research in many parts of the world, including Mexico, on how Transcranial DC Stimulation is beneficial for people with epilepsy. This new equipment allows us to formulate both possibilities, which also enables us to do what we call “high definition or highly selected montages”, which allows us to apply therapies during sleep in people with epilepsy using electrical stimulation.

I think it is part of what has to come, and we will be watching as it develops, but it is something we are already implementing in Neuro Sleep Clinic.

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