Excessive daytime sleepiness (EDS) and attentional deficits are often observed in people with epilepsy. They may be the consequence of seizures and subclinical discharges as well as of comorbid conditions as obstructive sleep apnea/hypopnea syndrome (OSAS), attention deficit hyperactivity disorder (ADHD), or other less frequent disorders. Excessive daytime sleepiness may also be caused or worsened by antiseizure medications (ASMs).

Several meta-analyses suggested that lamotrigine, lacosamide, and perhaps eslicarbazepine are less sedative than other traditional and new ASMs and, in patients prone to somnolence, might be preferred over ASMs with more sedative properties.

In patients with severe EDS and/or ADHD, advantages and risks of a treatment with a psychostimulant need to be considered. Methylphenidate, modafinil, armodafinil, pitolisant, and solriamfetol are authorized for use in ADHD and EDS in patients with narcolepsy and some of them also in OSAS. These agents are off-label for the treatment of EDS associated with epilepsy. They do not have proconvulsant effects, although there are several possible risks for patients with epilepsy. The risks of cardiovascular events and psychiatric symptoms should be carefully evaluated as such disorders can coexist with epilepsy and be triggered by these agents. Finally, combination of psychostimulants with ASMs may be associated with several pharmacokinetic drug–drug interactions.

癫痫患者经常会出现白天过度嗜睡（EDS）和注意力缺陷。它们可能是癫痫发作和亚临床放电以及阻塞性睡眠呼吸暂停/低通气综合征 (OSAS)、注意力缺陷多动障碍 (ADHD) 或其他不太常见的疾病等合并症的结果。抗癫痫药物 (ASM) 也可能导致或加剧白天过度嗜睡。

多项荟萃分析表明，拉莫三嗪、拉考沙胺和艾司利卡西平的镇静作用低于其他传统和新型 ASM，对于容易嗜睡的患者，可能比镇静作用更强的 ASM 更受青睐。

对于患有严重 EDS 和/或多动症的患者，需要考虑精神兴奋剂治疗的优点和风险。哌醋甲酯、莫达非尼、阿莫达非尼、匹托利桑和索里亚莫托被授权用于治疗 ADHD 和发作性睡病患者的 EDS，其中一些也用于治疗 OSAS。这些药物不适合治疗与癫痫相关的 EDS。尽管对癫痫患者存在多种可能的风险，但它们没有促惊厥作用。应仔细评估心血管事件和精神症状的风险，因为此类疾病可能与癫痫共存并由这些药物引发。最后，精神兴奋剂与 ASM 的组合可能与多种药代动力学药物相互作用有关。