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 familiar with. We also know that there are different types of epilepsy, such as seizures in which mental absence occurs without the affected person having a seizure.

Generally we imagine that the seizures 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.

• Related article: "Epilepsy: definition, causes, diagnosis and treatment"

What happens in 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 a hyperactivation on the 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 neuronal groups that for some more or less unknown reason (although sometimes the onset of symptoms goes back to an 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 relaxation of one or several muscle groups, and which tend to be repeated with some frequency. Another of the usual symptoms is the alteration of the state of consciousness, which is usually common to all or almost all types of epilepsy (either 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 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 since it occurs during sleep.

• You may be interested in: "Types of epilepsies: causes, symptoms and characteristics"

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 frequent that one or several crises of very short duration appear, which may or may not awaken the subject. Actually, almost all types of epilepsy could occur at night, but those considered epilepsy Nocturnal seizures are those in which all or most of the seizures occur during the period of sleep or passage to sleep. fall asleep/wake up

In nocturnal epileptic seizures there are usually seizures that give rise to sudden movements of the extremities, sometimes twisting. The appearance of screams and moans accompanying the episode is not uncommon. Likewise, when the alterations occur during sleep, the quantity and quality of the sleep of the affected decreases to a great extent, being frequent that there are several awakenings during the night or waking up with the feeling of not having had a good night's sleep. For this reason, it is common for subjects with this type of problem to present daytime hypersomnia.

Nocturnal epileptic episodes are usually sudden, and tend not to leave 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 that as the number and severity of the seizures grow, they are less, although without treatment it is unlikely that nocturnal epilepsy will remit.

Another important point to take into account is that nocturnal epilepsy often takes time to be diagnosed. And it is that when the crises appear during sleep, it is possible that even the affected person may not become aware of the presentation of said symptoms. Sometimes these symptoms are even attributed to other disorders, such as sleepwalking or night terrors.

• Related article: "What happens in a person's brain when they have seizures?"

Why is it produced?

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 such sensitivity remains unknown in most cases.

In nocturnal epilepsy, the seizures occur during periods of sleep or drowsiness, which makes us see that The discharges occur at a time when brain activity is changing between the different cycles of the brain. dream. Remember that sleep has different phases that They repeat themselves 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. Seizures are much more frequent during non-REM sleep, although they occasionally occur in REM sleep as well.

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

Two of the best known examples

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 at 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 generates various body sounds. Motor disturbances tend to be concentrated in the area of ​​the face.

The crises themselves appear at the time of waking up or during the night, mostly. The child is often conscious but not able to speak. In these cases it is common for them to experience panic due to the lack of control of 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 frequent that in this case the crises cause convulsions 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 surgery or vagus nerve stimulation may be considered using surgically implanted mechanisms, although these procedures can be more risky.

Bibliographic references:

• Carney, P.R. & Greyer, J.D. (2005). Clinical Sleep Disorders. Philadelphia: Lippincott, Williams, and Wilkins.

• Santin, J. (2013). Sleep and epilepsy. Clínica Las Condes medical journal, 24 (3); 480-485.