Nocturnal epilepsy: symptoms, causes and treatment

Epilepsy is a disease known since ancient times. Convulsions, tongue bites, falls, excessive salivation, loss of control of the sphincters … are symptoms experienced by a large part of those affected. We also know that there are different types of epilepsies, such as seizures in which mental absence occurs without the affected person convulsing.

We generally imagine that the seizures appear during the day, at times when the subject is active. However, sometimes epilepsy outbreaks also occur overnight. We are talking about nocturnal epilepsy.

    What happens in epilepsy?

    Epilepsy is a disorder of neurological origin in which the individual who suffers from it suffers from nervous breakdowns in which he loses control of his body or parts of it due to a hyperactivation of part of different neuronal groups.

    Although it can be affected by external stimuli such as light and stress, the problem is mainly caused by the presence of neural groups which for some reason more or less unknown (although sometimes the onset of symptoms can be traced back to a aggression, trauma or tumor) are hypersensitive, which are activated abnormally and this causes the generation of symptoms.

    As we said, although it does not appear in all cases and types of epilepsy the most characteristic symptom is the presence of seizures. These are sudden, uncontrolled twitching caused by the sudden, involuntary contraction and distension of one or more muscle groups, and which tend to recur with some frequency. Another common symptom is an altered state of consciousness, which is generally common to all or almost all types of epilepsy (such as complete loss of consciousness, clouding, or absence). In addition to them may appear incontinence, mutism, immobility, bites and injuries or salivation in the form of jokes.

    The particular type of symptoms will vary depending on the type of epilepsy, The area or areas of the brain that are activated and the level of generalization of the seizures. And there are different types of epilepsy. One of them is special because it occurs during sleep.

      Nocturnal epilepsy

      Nocturnal epilepsy is a type of epilepsy that is characterized by its onset mainly during periods of sleep typical of the affected individual. It is common for one or more seizures of very short duration to appear, Which may or may not wake up the subject. In reality, almost all types of epilepsy can occur during the night, but those considered nocturnal epilepsy are those in which all or most seizures occur during the sleeping period or the falling asleep / waking stage. .

      In nocturnal epileptic seizures, convulsions usually occur, causing sudden movements of the limbs, sometimes contortions. The appearance of screams and moans accompanying the episode is not uncommon. In addition, during sleep disturbances, the quantity and quality of sleep of those affected decreases considerably, and it is common for there to be several awakenings during the night or they wake up feeling they haven’t slept well. This is why it is common for people with this type of problem to suffer from daytime hypersomnia.

      Episodes of nocturnal epilepsy are usually sudden and tend not to leave post-seizure symptoms such as confusion or migraine. Sometimes, nocturnal epilepsy auras or pre-epidemic symptoms may also be seen, Such as the presence of tingling, difficulty breathing, dizziness or hallucinations.

      Nocturnal epilepsy is rare. Epidemiologically, it is much more common in children and adolescents, although it can appear at any age. In this sense, the number and severity of seizures tend to decrease as they develop, although without treatment nocturnal epilepsy is unlikely to subside.

      Another important point to keep in mind is that often nocturnal epilepsy takes a long time to diagnose. And it is that when the seizures appear during sleep, it is possible that even the affected person is not aware of the presentation of these symptoms. Sometimes these symptoms are even attributed to other disorders, such as sleepwalking or night terrors.

        Why is this happening?

        As with epilepsy in general, the causes of nocturnal epilepsy remain unclear. As in all types of epilepsy is attributed to the presence of hypersensitivity in certain areas of the brain that cause abnormal discharges, but the reason for this sensitivity remains unknown in most cases.

        In nocturnal epilepsy, the seizures occur during periods of sleep or numbness, which shows that the shocks occur at a time when brain activity changes between different sleep cycles. Remember that sleep has different phases they repeat in several cycles during the night or during sleep, And in each of them, brain activity varies and produces different types of waves. Seizures are much more common during non-REM sleep, although they sometimes also occur during REM sleep.

        The areas that produce the discharge can vary widely, although the most common nocturnal epilepsy is usually generated in the frontal lobe.

        Two of the best known examples

        Although we have talked about nocturnal epilepsy as a single disorder, the truth is that different epilepsy subtypes can be found in which seizures occur at night.

        Rolandic epilepsy

        This type of epilepsy, usually originating from Rolando’s fissure, is characterized by the presence of partial-type motor seizures. The patient usually stands up and generates various bodily sounds. Motor alterations are usually concentrated in the facial area.

        The seizures themselves appear upon awakening or at night, mostly. It is common for the child to realize that he cannot speak. In these cases, it is common to panic due to the lack of control of the body itself.

        Autosomal dominant nocturnal frontal epilepsy

        It is one of the few types of epilepsy for which a genetic correlate has been found, particularly the presence of mutations in the CHRNA4 gene. It is common in this case for seizures to provoke seizures of the trunk and limbs.

        treatment

        The main treatment for nocturnal epilepsy is usually the use of anticonvulsant drugs such as carbamazepine, valproate, gabapentin or oxcarbazepine.

        too much surgery or vagus nerve stimulation may be considered by surgically implanted mechanisms, although these procedures may be riskier.

        Bibliographical references:

        • Carney, PR and Grayer, JD (2005). Clinical sleep disorders. Philadelphia: Lippincott, Williams and Wilkins.
        • Santín, J. (2013). Sleep and epilepsy. Medical journal Clínica Les Comtes, 24 (3); 480-485.

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