Nocturnal epilepsy

Nocturnal epilepsy is a seizure disorder in which seizures occur while sleeping, within an hour of waking or an hour before bedtime.^[1] Several common forms of epilepsy, including frontal lobe epilepsy, can manifest in a nocturnal state.

Epilepsy can be nocturnal if the form of epilepsy triggers seizures only while one is asleep, or if one normally has seizures that occur at that time. In the latter example, if the subject stays awake at a time when he is normally sleeping, the subject may have the seizure while awake. Noting this, it is important for the subject to maintain a proper sleeping cycle. Diverting from proper sleep patterns can trigger more frequent epileptic symptoms in people who are diagnosed with nocturnal epilepsy and, as mentioned before, even while awake.^[2]

Diagnosis

The condition may be difficult to diagnose. The subject may be unaware they have a seizure disorder.^[3] To others, the involuntary movements made during sleep may appear no different from those typical of normal sleep.^[4] People who have nocturnal seizures may notice unusual conditions upon awakening in the morning, such as a headache, having wet the bed, having bitten the tongue, a bone or joint injury, muscle strains or weakness, fatigue, or lightheadedness. Others may notice unusual mental behaviors consistent with the aftermath of a seizure.^[5] Objects near the bed may have been knocked to the floor, or the subject may be surprised to find themselves on the floor.

There are many risks associated with nocturnal seizures including concussion, suffocation and sudden unexpected death (SUDEP).

Type

A person who suffers from epilepsy regardless of whether it is nocturnal or not, can be categorized into two different types of epilepsy either being generalized, or partial. A generalized epilepsy syndrome is associated with an overall hyperactivity in the brain, where electrical discharges occur all over the brain at once; this syndrome often has a genetic basis. While generalized epilepsy occurs all over the brain, partial epilepsy consists of a regional or localized hyperactivity, which means that the seizures occur conversely in one part of the brain or several parts at once.^[2]

Treatment

Like other forms of epilepsy, nocturnal epilepsy can be treated with anti-convulsants.^[6] Despite the effectiveness of anti-convulsants in people who suffer from nocturnal epilepsy, the drugs are shown to disrupt a person's sleeping structure.^[7] This may cause concern in people who suffer specifically from nocturnal epilepsy because undisrupted sleep is important for these people, as it lowers the likeliness of epileptic symptoms to arise.

One particular study by V. Bradley and D. O'Neill analysed the different forms of epilepsy, including nocturnal epilepsy and its relationship with sleep.^[2] They found that some patients only experienced epileptic symptoms while they are asleep (nocturnal epilepsy), and that maintaining good sleep helped in reducing epileptic symptoms. Another study determined that anti-convulsant medications can minimize epilepsy not just in people who are awake, but also in people who are asleep. However, some of these anti-convulsant medications did also have adverse effects on subjects' sleeping structures, which can exacerbate epileptic symptoms in people who suffer from nocturnal epilepsy.

To minimize epileptic seizures in these people, it is important to find an anti-convulsant medication that does not disrupt a person's sleeping structure. The anti-convulsant medications that were tested to meet this criterion are: phenobarbital, phenytoin, carbamazepine, valproate, ethosuximide, felbamate, gabapentin, lamotrigine, topiramate, vigabatrin, tiagabine, levetiracetam, zonisamide, and oxcarbazepine.^[2] Oxcarbazepine is shown to have the least amount of adverse effects on sleep. Another study shows that it enhances slow wave-sleep and sleep continuity in patients with epilepsy.^[2][7]

References

Sources

• Manford, Mark (2003), Practical Guide to Epilepsy, Butterworth-Heinemann, ISBN 978-0-7506-4621-5 

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