Sleep in Epilepsy Special Interest Group | Brain Flow Dynamics and Sleep Alterations Effect on EpilepsyFrom Babies to Late Adults and Breathing to Cognition: The Impact of Sleep on Seizures and Cognitive Function in Epilepsy Through the Lens of Water Exchange Dynamics

Myriam Abdennadher; Laurie Douglass; Rani Sarkis; Rup K. Sainju; Rinat Jonas; Ning Hua; Marcus Ng; Milena K. Pavlova

doi:10.1177/15357597261418772

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Sleep in Epilepsy Special Interest Group | Brain Flow Dynamics and Sleep Alterations Effect on EpilepsyFrom Babies to Late Adults and Breathing to Cognition: The Impact of Sleep on Seizures and Cognitive Function in Epilepsy Through the Lens of Water Exchange Dynamics

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Sleep in Epilepsy Special Interest Group | Brain Flow Dynamics and Sleep Alterations Effect on EpilepsyFrom Babies to Late Adults and Breathing to Cognition: The Impact of Sleep on Seizures and Cognitive Function in Epilepsy Through the Lens of Water Exchange Dynamics

Myriam Abdennadher, Laurie Douglass, Rani Sarkis, Rup K. Sainju, Rinat Jonas, Ning Hua, Marcus Ng and Milena K. Pavlova

Epilepsy currents

02/25/2026

DOI: 10.1177/15357597261418772

PMCID: PMC12935584

PMID: 41768594

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Abstract

Decades of research have demonstrated the complex intersection between sleep and epilepsy, which significantly impacts seizure control and epilepsy-related comorbidities. However, further investigation is needed to understand the underlying mechanisms linking sleep and epilepsy. Brain exchanges are dynamic processes that include blood-to-brain transport across the blood–brain barrier (BBB), where metabolism is regulated to sustain neural activity, and brain-to-blood and cerebrospinal fluid clearance via the glymphatic system. Together, the BBB and glymphatic system maintain brain milieu homeostasis, and dysfunction at any level can contribute to neurological disorders, including epilepsy. This review highlights the dynamics of water flow within the brain and explores the interrelationship between exchange and clearance pathways across the lifespan, as presented at the 2025 American Epilepsy Society Sleep and Epilepsy Special Interest Group Session. We provide an overview of (1) sleep-related breathing disturbances, their effects on seizures and cognitive function throughout the lifespan, and their implications for sudden unexpected death in epilepsy; and (2) the role of water dynamics mediated by the BBB and the glymphatic system in modulating sleep and epilepsy. These insights deepen our understanding of epilepsy severity and the role of sleep in modifying disease progression, offering promising directions for future research to advance therapeutic strategies.

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Title: Subtitle: Sleep in Epilepsy Special Interest Group | Brain Flow Dynamics and Sleep Alterations Effect on EpilepsyFrom Babies to Late Adults and Breathing to Cognition: The Impact of Sleep on Seizures and Cognitive Function in Epilepsy Through the Lens of Water Exchange Dynamics
Creators: Myriam Abdennadher - Boston University
Laurie Douglass
Rani Sarkis - Boston University
Rup K. Sainju - University of Iowa
Rinat Jonas - Boston University
Ning Hua - Boston University
Marcus Ng - University of Manitoba
Milena K. Pavlova - Boston University
Resource Type: Journal article
Publication Details: Epilepsy currents
DOI: 10.1177/15357597261418772
PMID: 41768594
PMCID: PMC12935584
NLM abbreviation: Epilepsy Curr
ISSN: 1535-7597
eISSN: 1535-7511
Publisher: American Epilepsy Society
Grant note: NIH through the Boston University (BU) Center for Translational Science Institute: 1UL1TR001430 Philips LLC, North AmericaNINDS- NIH: U01 NS090414, R01 NS113764-01, R01 NS113764-02 CURE Epilepsy
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Myriam Abdennadher received research funding from NIH through the Boston University (BU) Center for Translational Science Institute (1UL1TR001430) and Philips LLC, North America. Dr Rup K. Sainju received research funding from NINDS- NIH (U01 NS090414, R01 NS113764-01 and R01 NS113764-02), CURE Epilepsy, and Neurava Inc.
Language: English
Electronic publication date: 02/25/2026
Academic Unit: Neurology
Record Identifier: 9985139305802771

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