Nocturnal epilepsy: symptoms, causes and treatment

March 30, 2024

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

We usually imagine that crises appear during the day, at times when the subject is active. However, epileptic seizures sometimes also occur during the 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 suffering from it undergoes 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 caused mainly by the presence of neuronal groups that for some reason more or less unknown (although sometimes the onset of symptoms can be traced back to an aggression, traumatism or tumor) are hypersensitized, which is activated abnormally and this 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 abrupt and uncontrolled jerks generated by the sudden and involuntary contraction and distension of one or several muscle groups, and tend to recur with some frequency. Another common symptom 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 may appear incontinence, mutism, immobility, bites and injuries or salivation in the form of frothing.

The type of symptoms in particular will vary according to the type of epilepsy , the area or brain areas that are activated and the level of generalization of the crises. And there are different types of epilepsies. One of them is special since it occurs during sleep.

Perhaps you are interested: "Types of epilepsies: causes, symptoms and characteristics"

The nocturnal epilepsy

Nocturnal epilepsy is a type of epilepsy that is characterized by appearing mainly during the typical periods of sleep of the affected individual. It is common to see one or several crises of very short duration , which may or may not wake the subject. Actually, almost all types of epilepsy may occur during the night, but those considered as nocturnal epilepsy are those in which all or most of the crises occur during the period of sleep or the step to sleep / wake up.

In crises of nocturnal epilepsy there are usually seizures that give rise to abrupt movements of the limbs, sometimes contorting. The appearance of screams and moans accompanying the episode is not uncommon. Likewise, during the sleep, alterations in the quantity and quality of sleep of those affected decrease to a great extent, being frequent that there are various awakenings during the night or that wake up with the sensation of not having slept in a restorative way . For this reason, it is usual for you to be subject to this type of problem with daytime hypersomnia.

Episodes of nocturnal epilepsy are usually abrupt, and tend not to leave symptoms after the crisis such as confusion or migraine. Sometimes, in nocturnal epilepsy, auras or symptoms prior to the outbreak can also be observed , such as the presence of tingling, breathing difficulties, vertigo or hallucinations.

Nocturnal epilepsy is not frequent. At the 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 decrease as the number of seizures grows, although without treatment it is unlikely that nocturnal epilepsy will subside.

Another important point to keep in mind is that often, nocturnal epilepsy is slow to be diagnosed . And is that the emergence of crises during sleep is possible that even the affected may not be aware of the presentation of these symptoms. Sometimes these symptoms are even attributed to other alterations, 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 this sensitivity remains an unknown in most cases.

In nocturnal epilepsy, seizures occur during periods of sleep or numbness, which makes us see that discharges occur at a time when brain activity is changing between different sleep cycles. Recall that the dream has different phases that they are repeated in several cycles during the night or the time we sleep , and in each of them the brain activity is changing and producing different types of wave. The attacks are much more frequent during non-REM sleep, although occasionally they also happen in REM sleep.

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 the crises happen during the night.

Rolandic epilepsy

This type of epilepsy usually originated in Rolando's fissure is characterized by the presence of partial-type motor seizures. The patient usually gets up and generates different body sounds. The motor alterations usually concentrate in the area of the face .

The crises themselves appear at the time of waking up or during the night, mostly. Often the child is conscious but not able to speak. In these cases it is common to experience panic in the absence of control of one's 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 seizures provoke convulsions of the trunk and extremities.

Treatment

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

As well The use of surgery or vagus nerve stimulation may be considered by means of surgically implanted mechanisms, although these procedures can be more risky.