What causes nocturnal seizures? Symptoms, diagnosis, and treatment for nocturnal epilepsy

What are nocturnal seizures?

Nocturnal seizures are when a person experiences a seizure during sleep. The condition may also be referred to as nocturnal epilepsy. People who suffer from nocturnal seizures often go unaware they suffered from one at all, but may find it difficult to wake up or to stay awake. Nocturnal seizures might occur just after a person has fallen asleep, just before waking, during a daytime nap, or simply when in a state of drowsiness.

The precise reasons why nocturnal seizure in adults occurs is not fully understood but it is thought to be a central nervous system disorder where nerve cell activity in the brain become disrupted leading to seizures development. This may cause periods of unusual behavior and sensations, and sometimes even loss of consciousness.

Causes of nocturnal seizures

The neural network of the brain is infinitely complex, with millions of connections making up our consciousness and controlling our daily operations. Nocturnal seizure causes can be the result of any abnormality affecting the brain and its function, some of which we don’t realize are affecting our central nervous system. the following are various nocturnal seizure causes:

Injuries

While the brain is protected by the skull, injury to delicate brain tissue can still occur within it. Bumping your head or direct blunt for trauma to the skull can violently move the brain within the skull leading to contusion (injury). If the force striking the head is hard enough to break through the skull it can lead to massive swelling and inevitable brain damage. Seizure tends to develop several years after a traumatic incident.

Alcohol and Drug Abuse

When using substances of abuse like these, it creates a chemical shift within the brain to the point that if a person were to suddenly stop, I can lead to severe withdrawal symptoms or even seizure development. This is why people who are detoxifying from severe alcohol abuse are encouraged to do so in a clinic or detox facility so they are constantly under supervision

Sleep deprivation

A possible trigger for seizures especially for those who are prone to develop nocturnal seizures

Changes in brain electrical activity

During sleep, our brain goes through several sleep stages, of which our brains channel through various electrical brain wave changes. A particular brain wave may trigger a nocturnal seizure

Fevers and stress

Stress can affect the mental process of the brain which can, in turn, be a possible trigger for nocturnal seizures.

Stimulant use

This may include stimulants such as coffee, commonly used to overcome day time drowsiness. However, drinking too much coffee and therefore caffeine can be a possible trigger for nocturnal seizures.

Sedative use

Commonly used by those suffering from sleeplessness, sedatives have been known to aggravate nocturnal seizure problems.

Certain seizure conditions

Those already suffering from a pre-existing seizure disorder may be more prone to developing nocturnal seizures. These disorders include Awakening tonic-clonic, juvenile myoclonic epilepsy, benign rolandic epilepsy, Landau-Kleffner Syndrome (LKS), and frontal lobe epilepsy.

Seizures can be linked to

Unusual brain development, stroke, brain tumor, brain infection (meningitis or encephalitis), brain hypoxia (decreased oxygen to the brain)

Symptoms of nocturnal seizures

Nocturnal seizure symptoms can be difficult to recognize as they occur when the affected person is asleep. However, if you’re more aware of the signs of nocturnal seizure you will be more likely to pick up on their occurrence. The following are some of the most common consequences and what do nocturnal seizures look like.

Inability to concentrate: Having difficulty concentrating and focusing during awake hours could be a nocturnal seizure sign. This is partly due to the fact that having seizures while sleeping greatly reduces the time spent in deep sleep leading to negative effects on your health and lifestyle.
Involuntary movement: This is characterized by abnormal movements during sleep. Some individuals suffering from nocturnal seizures wake up multiple times during the night due to thrashing movements of the arms and/or legs that they have no control over. Patients often are jarred awake and left in a state of disorientation and confusion.
Tongue biting and incontinence: Both hallmark signs of suffering from a seizure episode which could be exacerbated in cases of nocturnal seizure disorder. While sleeping, all of your bodily muscles are relaxed which could make you more susceptible to wetting the bed. Sometimes certain muscle groups can rigorously contract when suffering from a seizure, if this happens to the jaw muscles you could easily bite your tongue.
Other symptoms of nocturnal seizures:
- Headache upon awakening
- Drowsiness
- Increased day time seizures due to drowsiness
- Injury to joints or bones
- Lightheadedness
- Muscle strain/weakness
- Behavioral changes
- Signs of sleeplessness – drooling, headache, and vomiting

Diagnosis of nocturnal seizures

Identifying and diagnosing nocturnal seizures can be quite difficult for medical professionals as the symptoms that are often produced don’t immediately point to your having a seizure during sleep. The person affected may also be unwittingly subject to nocturnal seizures and simply sees a doctor for their excessive drowsiness and lack of concentration.

In order for an accurate diagnosis of nocturnal seizures to be made, it begins with an astute physician to recognized odd sleeping behavior. While they this may not be completely sure your symptoms are due to nocturnal seizure, they will keep it in their differential diagnosis just in case it happened to be the reason.

Many sleep disorders may have over lapping symptoms when compared to nocturnal seizures. Wetting the bed, nocturnal muscle strains, or even falling out of bed, can be part of several other disorders. But by asking if there is any previous seizure history, any family history of epilepsy or seizure, and current medications that are being used, it can help paint a clearer picture to why you are suffering from these symptoms.

When the diagnosis of a nocturnal seizure is suspected a more detailed look at the brain is warranted. This will come in the form of an electroencephalogram (EEG) when the person is sleeping to get a look at the brain waves during each stage. A CT or MRI can be done to get a gross image of the brain looking for any structural abnormalities. Also, information from a spouse or family member on your sleep patterns would be useful.

Why do nocturnal seizures occur?

Having seizure during sleep can be a feature of virtually any type of epilepsy. Some people have seizures exclusively during the night, while others can have a seizure that occurs both during the daytime and nighttime. The International League Against Epilepsy (ILAE) defines nocturnal seizures as seizures occurring exclusively or predominantly (greater than 90%) from sleep. An estimated 12 percent of people with epilepsy have nocturnal seizures.

It is believed that nocturnal seizures are strongly influenced by the sleep-wake cycle. The process of sleep is quite complicated with many physiologic changes occurring the body and especially the brain. There are a total of five different stages of sleep which are characterized by brain wave changes. This electrical activity within the brain moves a person between the different stages with the brain constantly cycling through them throughout the night.

Out of all the stages, the fifth stage or rapid eye movement stage (REM) doesn’t seem to induce seizure activity. The remaining four stages are therefore the most likely place for nocturnal seizures to occur. Stages one and two, also called light sleep phase, are often regarded as being the most common seizure stage of sleep.

Can nocturnal seizures change to daytime seizures?

Long standing nocturnal seizure for many years decreases the likelihood of experiencing a seizure during the daytime as seizure condition of such duration seldom deviate from their common presentation. However, daytime seizures are still a risk and may develop in cases of extreme stress or sleep deprivation, medication changes or withdrawal, or in cases of poor seizure management.

Facts to know about sleep & nocturnal seizures

Sleep deprivation is one of the most common seizure triggers for many people with epilepsy
Nocturnal seizures often disrupt sleep and increase daytime drowsiness
Drowsiness can increase the risk of daytime seizures for people affected by nocturnal seizures
Sudden Unexpected Death in Epilepsy (SUDEP) can be a complication of nocturnal seizures
Certain sleep disorders may be misdiagnosed as epilepsy or nocturnal seizures
Sleeping difficulties or daytime drowsiness may be exacerbated by some antiepileptic drugs designed to reduce seizure activity
Sleep apnea is about twice as common in people with poorly controlled epilepsy than in the general population
Poorer quality of life is often a feature in people with epilepsy with sleep disturbances. Treatment of the underlying sleep disorder can subsequently improve seizure control and therefore quality of life for the patient

Safety Measures for Patients Suffering from Nocturnal Seizures

Knowing what to do in a time of a seizure episode is often considered a vital part of nocturnal seizures treatment. It helps to ensure that the patient safety is being looked after to prevent any long term complications. Such safety measures include:

The avoidance of using large, soft pillows as they increase the risk of suffocation due to smothering
Padded bed headboards to prevent potential head trauma
Placement of padded safety mats beside the bed to protect from injurious falls during nocturnal seizures
All breakable bedside devices should be placed away from the bed as they may be easily knocked over during a nocturnal seizure. This includes lamps, alarm clocks, or other decorative fixtures.
Avoid smoking in bed as it is a serious fire hazard
Avoid lining your bed room with course carpet as they could cause friction burns in patients who frequently fall
Practice good sleep habits, waking and sleeping at regular times
Avoid shift work oriented jobs, as they may interfere with your sleep cycle
Avoid the use of sleep sedatives as they may exacerbate nocturnal seizures. Instead, explore more natural sleep remedies
Invest in low lying bed frame and avoid sleeping on top bunks

How to treat nocturnal seizures?

Seizures are generally treated using prescription anticonvulsant medication. These are a diverse group of antiepileptic/anti-seizure drugs that work by suppressing the excessive rapid firing of neurons during seizures. Anticonvulsants also help to prevent the spread of a seizure within the brain. These medications often come with a whole bunch of side effects such as fatigue, nausea, and weight gain. But their use has been proven to reduce the chances of death and devastating neurological complications that seizure often inflict.

Commonly used anticonvulsant medication used for nocturnal seizures include: Phenytoin, Phenobarbital, Carbamazepine, Ethosuximide, Valproate, Gabapentin, Felbamate, Lamotrigine, Vigabatrin, Topiramate, Levetiracetam, Tiagabine, Oxcarbazepine and Zonisamide.

Nocturnal seizures, in particular, have a close relationship to our sleep cycle. This means that proper sleep habits can be an effective option for those suffering from this type of seizure. However, medication is still considered first line treatment therapy, but due to their side effects, they may disturb sleep to some degree. Your doctor will try to find the most beneficial medication that causes minimal side effect and doesn’t prevent excessive sleep disturbance but also stress the importance of good sleep practices as effective treatment for nocturnal seizures.