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Unraveling the Complex Interplay Among Epilepsy, Cognitive Impairment, and Sleep Disruption

By Daniel J. Bonthius, MD, PhD | Winter 2023

Chair of the Board of Directors of the National Sleep Foundation Board Dr. Temitayo Oyegbile-Chidi makes a point.

Throughout most of medical history, epilepsy has been considered principally a problem of seizures.  However, in recent years, the fact has become clear that epilepsy is more than just a seizure disorder.  Most patients with epilepsy also have issues with cognition, behavior, mental health, and sleep.  Furthermore, these factors can interact in complex ways to improve or worsen each other.  Undaunted by the complexity of the problem, Dr. Temitayo Oyegbile-Chidi is working diligently to unravel these interactions, with the hope of developing new therapies to improve them. 

Dr. Temitayo Oyegbile-Chidi is a clinical associate professor in the Department of Neurology at UC Davis.  The daughter of two Nigerian physicians, Dr. Oyegbile-Chidi completed an MD-PhD degree at the University of Wisconsin, where she studied Biopsychology and was first introduced to the idea that epilepsy and cognitive dysfunction can drive each other. 

Following a child neurology residency at New York Presbyterian Hospital, Temitayo (“Temi”) completed a fellowship in sleep medicine at Northwestern Memorial Hospital.  Through her training in the diagnosis and treatment of sleep disorders, Temi began to realize that sleep, cognition, and epilepsy are interwoven in manifold ways.  Sleep deprivation worsens seizures and cognitive performance, while seizures exacerbate sleep problems and cognitive deficits.

Since completing her training, Temi has sought to understand how sleep, epilepsy, cognition, and behavior affect each other at the biological level and how therapies aimed at one of these factors can affect them all. 

Among her many fascinating findings, Temi has discovered, through the use of quantitative and functional MRI, that cognitive dysfunction in people with epilepsy is reflected in volumetric changes in the brain and in changes in activation and connectivity. Furthermore, utilizing neuropsychological test batteries, Temi has shown that, for children with new-onset epilepsy, sleep disturbance correlates with behavior problems, cognitive scores, and depression (Figure 1).

Because seizures, cognition, sleep, and behavior are all closely interwoven, Temi hopes that improvement in one of these factors may improve the others. In particular, she hypothesizes that modulation of sleep may reduce seizures, elevate cognition, and improve behavior in children with epilepsy.

She aims to test this hypothesis by providing acoustic stimulation (audible tones) to children with epilepsy during sleep and measuring seizures, cognitive performance, and behavior ratings. Through this novel and exciting line of research, Temi may shed considerable new light on a set of problems central to child neurology and may offer entirely new lines of therapy for patients with epilepsy.

Figure 1.
A. Relationship between sleep and behavior (CBCL) in epilepsy. Over a 36-month period, children with epilepsy who have persistently abnormal sleep exhibit more behavioral problems than those with persistently normal sleep. (Internalizing behavior – e.g., sadness, low self-esteem, behavioral inhibition, and fears; Externalizing behavior – e.g., aggression, delinquency, and hyperactivity; and Total behavior – both internalizing and externalizing) B. Relationship between sleep and cognition in epilepsy. Over a 36-month period, children with epilepsy who have persistently abnormal sleep exhibit poorer performance on cognitive testing than those with persistently normal sleep. Cognitive testing included language, executive function, verbal memory/learning, and processing speed. *p<0.05

EDITOR’S NOTE | Temitayo Oyegbile-Chidi has personified boldness and courage throughout her life. As a 16-year-old girl, she came to the US, alone, from Nigeria, to pursue her education. As a researcher, she is undeterred by the complexities of epilepsy, cognition, and sleep. Just meeting her boosts one’s ego.