11 February 2025

Epilepsy affects around 600K people in the UK, and new tools have the potential to significantly improve our understanding of the intricate relationship between this disabling condition and harmful sleep disorders. Sleep has been proven to significantly impact health outcomes so identifying people who need the support of sleep services is vital to improving outcomes and quality of life for this patient population. Methods commonly used to identify sleep disorders in people with epilepsy miss important pieces of data, so KHP News spoke to Elisa Bruno, to find out how her research aims to find a new way of gathering sleep quality data from this patient group. 

Tell me about your role

I trained in neurology in Italy and moved to the UK to focus on epilepsy research. When I was introduced to Prof Mark Richardson, he was just starting work on a new collaborative project called RADAR-CNS. The project was set up to explore the use of wearable technology in epilepsy, something which aligned with my interests perfectly. I was quick to join the project as a King’s College London clinical fellow and I even went on to complete a PhD with RADAR-CNS.  

Consultants who specialise in epilepsy often have an interest in sleep for the interconnection between these two conditions and for the shared tools that we use to study them. So, I jumped at the opportunity to work in the Sleep Disorders Centre at Guy’s Hospital alongside Prof Guy Leschziner, where I started deepening my knowledge on sleep and epilepsy and exploring their relationship. 

How is sleep and epilepsy connected? 

Currently we only have retrospective data — population data that comes from questionnaires — so the literature is not so precise. Nonetheless, the literature strongly suggests that one third of patients with epilepsy also have sleep disorders. What we cannot gather from the literature is whether this trend is the result of primary sleep disorders, the use of anti-seizure medications, or seizures occurring at night. Some studies have found primary sleep disorders, such as obstructive sleep apnoea, often occur as a comorbid condition in epilepsy. The data is intriguing and has motivated me to study the link between primary sleep disorders and epilepsy. 

Can sleep monitoring devices help patients with epilepsy? 

Sleep disorders are prevalent in epilepsy, but they often go undiagnosed. A patient may have multiple comorbidities, but it is not always possible to screen for them in a 15-minute appointment. Important aspects of health, like sleep, can easily go unchecked. A wearable device could help clinicians get the information they need quickly and help to identify patients who need to be referred to sleep services.  

Guidance around sleep and epilepsy can be vague and difficult for patients to apply. Clinicians always say get a good night’s sleep because sleep deprivation can lead to seizures. However, we don’t know if the duration of sleep is linked to seizures, or if another aspect of sleep could be responsible. Sleep is a multi-dimensional construct including different parameters, such as regularity and timing, so a wearable device that provides data around those characteristics might enable more specific counselling for patients.  

Patients with epilepsy are calling for sleep to be addressed and it is backed up by scientific societies who recognise that patients with epilepsy and sleep disorders have a worse quality of life. One patient told me, ‘addressing sleep is as important as finding the right anti-seizure medication for my epilepsy because it can drastically improve my quality of life’.  

What are the best sleep monitoring devices for people with epilepsy?  

There are a lot of consumer devices for tracking sleep. Some of these devices are great for establishing a high-level picture of sleep, but they are not precise when it comes to identifying specific sleep parameters or sleep stages. Some research devices are more focused on sleep tracking, but they have never been used in people with epilepsy — who might be affected by seizures during the night — so we don't know how precise these wearable devices would be for tracking sleep in this patient group.  

Through patient and public involvement, I learned people want non-intrusive devices to track their seizures and sleep in the long term. Their feedback inspired me to focus on wrist devices. Now I am running a pilot study with the wrist device Empatica Embrace Plus. I want to study how well this wearable device measures sleep parameters compared with sleep diaries that clinicians usually use to assess sleep duration and quality. 

How does this technology use a mind and body approach? 

 Patients with sleep disorders experience greater levels of anxiety and depression, as well as reduced performance in terms of cognitive functions. Anxiety and depression can affect sleep, altered sleep can make seizures worse, and seizures can disrupt sleep — it is a vicious cycle. We might not be able to tell where the problem stems from, but by addressing sleep we might interrupt the cycle. By reducing the burden of sleep disorders, we could reduce the probability of patients with epilepsy experiencing seizures and developing cognitive issues or psychiatric comorbidities. 

How does partnership working benefit your research? 

 I'm privileged to work across academic and clinical settings. Partnership working gives me the chance to create multi-disciplinary projects and apply my research to different populations. I feel that I can deliver better care to my patients because I work across academic and clinical fields. I can develop research informed by patients’ needs, shaped by their views and share the most important discoveries from my research with my patients. It gives me a direct way of implementing my research findings into clinical practice.

Find out more about the work of KHP Neurosciences.