Is Central Sleep Apnea related to Epilepsy or seizure meds?

[adwalter]

My 16 year-old daughter has complex partial seizures.  They have been under control for around 7 months now.  She takes 700 mg. of lamictal, 24 mg. gabitril, and 37.5 mg. effexor each day in addition to having the VNS implant.  She was recently diagnosed with central sleep apnea, the results being she is very tired and having extreme memory problems. (The sleep study showed that she never even gets into REM sleep)  A recent CT scan showed nothing that would cause the sleep apnea.  Do medications such as lamictal or gabitril cause sleep apnea?  Her neurologist is afraid to lower the dosage because she is afraid the seizures will return.  While I definitely understand this, I also know my child's quality of life is not good, either.  School work and tests are a nightmare because of the memory problems.  An ENT examined her and verified there is no obstruction.  I am frustrated and want to find a happy medium where the seizures will not come back, but that she can find a way to clear up the sleep apnea.  She is on a CPAP machine; however, it is not that beneficial because she manages, in her sleep, to pull it off.  Any advice you can give will be greatly appreciated.  By the way, my daughter has been a patient at the Cleveland Clinic and your staff is the best!

[CCF-Neuro-M.D.-CS]

I am aware of no connection between central sleep apnea and lamictal or gabitril. Was the sleep study done with complete EEG electrodes, to exclude that the events are not seizures. Also a syndrome called upper airway resistance syndrome can be difficult to diagnose on a routine sleep study, and may require a special sleep study with a probe placed in the esophagus. These are the two avenues I would assess first. If you are in the area, Dr Kotagal is one of our pediatric epilepsy/sleep doctors who may be able to assist you with this problem. Good luck.