Nocturnal Epilepsy: Symptoms, Causes And Treatment
Epilepsy is a disease known since ancient times. Seizures, tongue biting, falls, excessive salivation, loss of sphincter control… are symptoms that a large part of those affected are aware of. We also know that there are different types of epilepsies, such as seizures in which mental absence occurs without the affected person ever having a seizure.
Generally we imagine that crises appear during the day, at times when the subject is active. However, epileptic seizures sometimes also occur at night. We are talking about nocturnal epilepsy.
Epilepsy is a disorder of neurological origin in which the individual who suffers from it suffers nervous breakdowns in which he loses control of his body or parts of it due to an hyperactivation 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 neuronal groups that for some more or less unknown reason (although sometimes the onset of symptoms can be traced back to aggression, trauma, or tumor) are hypersensitized, which activates abnormally and causes the generation of symptoms.
As we have 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 and uncontrolled jerks generated by the sudden and involuntary contraction and distension of one or more muscle groups, and which tend to be repeated with some frequency. Another of the common symptoms is the alteration of the state of consciousness, which is usually common to all or almost all types of epilepsy (whether as complete loss of consciousness, obtundation or absence). In addition to them, incontinence, mutism, immobility, bites and injuries or salivation in the form of foam may appear.
The specific type of symptoms will vary depending on the type of epilepsy, the brain area or areas that are activated and the level of generalization of the seizures. And there are different types of epilepsies. One of them is special since it occurs during sleep.
nocturnal epilepsy
Nocturnal epilepsy is a type of epilepsy that is characterized by appearing mainly during the typical sleep periods of the affected individual. It is common for one or more crises of very short duration to appear, which may or may not awaken the subject. In reality, almost all types of epilepsy could occur during the night, but those considered nocturnal epilepsy are those in which all or most of the seizures occur during the sleep period or the transition to falling asleep/waking up.
In nocturnal epileptic seizures, seizures usually occur that give rise to sudden movements of the extremities, sometimes twitching. The appearance of screams and moans accompanying the episode is not uncommon. Likewise, when the alterations occur during sleep, the quantity and quality of sleep of those affected greatly decreases, and it is common for there to be various awakenings during the night or that they wake up with the feeling of not having slept restfully. Therefore, it is common for subjects with this type of problem to present daytime hypersomnia.
Episodes of nocturnal epilepsy are usually sudden, and tend to leave no post-seizure symptoms such as confusion or migraine. Sometimes, In nocturnal epilepsy, auras or symptoms prior to the outbreak may also be observed such as the presence of tingling, breathing difficulties, vertigo or hallucinations.
Nocturnal epilepsy is not common. At an epidemiological level, it is much more common in children and adolescents, although it can appear at any age. In this sense, there is a tendency for the number and severity of seizures to become smaller as they grow, although without treatment it is unlikely that nocturnal epilepsy will ever subside.
Another relevant point to take into account is that nocturnal epilepsy often takes a long time to diagnose. And when seizures appear during sleep, it is possible that the affected person may not even be aware of the presentation of said symptoms. Sometimes these symptoms are even attributed to other disorders, such as sleepwalking or night terrors.
Why does it occur?
As with epilepsy in general, the causes of nocturnal epilepsy remain unclear. As in all types of epilepsy It is attributed to the presence of hypersensitivity in some brain areas that cause abnormal discharges, but the reason for this sensitivity remains a mystery in most cases.
In nocturnal epilepsy, seizures occur during periods of sleep or drowsiness, which makes us see that the discharges occur at a time when brain activity changes between different sleep cycles. Let us remember that sleep has different phases that They repeat in several cycles during the night or the time we sleep, and in each of them the brain activity varies and produces different types of waves. Attacks are much more frequent during non-REM sleep, although they sometimes also occur in REM sleep.
The areas that produce the discharge can vary greatly, although the most common nocturnal epilepsy usually occurs in the frontal lobe.
Although we have been talking about nocturnal epilepsy as a single disorder, the truth is that different subtypes of epilepsy can be found in which seizures occur during the night.
Rolandic epilepsy
This type of epilepsy, generally originating in Rolando’s fissure, is characterized by the presence of partial motor seizures. The patient usually gets up and makes various body sounds. Motor alterations are usually concentrated in the facial area.
The seizures themselves appear at the moment of waking up or during the night, mostly. It is common for the child to be conscious but not able to speak. In these cases it is common for them to experience panic due to the lack of control over their own body.
Autosomal dominant nocturnal frontal epilepsy
It is one of the few types of epilepsy for which a genetic correlate has been found, specifically the presence of mutations in the CHRNA4 gene. It is common that in this case the crises cause seizures of the trunk and extremities.
Treatment
The main treatment applied in cases of nocturnal epilepsy is usually the use of anticonvulsant drugs such as carbamazepine, valproate, gabapentin or oxcarbazepine.
Also the use of surgery or vagus nerve stimulation may be considered through surgically implanted mechanisms, although these procedures can be more risky.
