Nocturnal Seizures

Symptoms

Nocturnal seizures are often unnoticed because the patient is asleep when they happen. However, there are signs that may suggest the patient's is experiencing these seizures, including:

• Loss of bladder control
• Biting their tongue

If the patient notices these symptoms of interrupted sleep they should talk to their doctor:

• Difficulty concentrating
• Awaking suddenly for an unknown reason
• Feeling drowsy
• Increase in daytime seizures triggered by a lack of sleep

Involuntary muscle movement linked to seizures can include:

• Stiff arms
• Stiff legs
• Jerking body movements

Causes and Risk Factors

The cause of seizures is often unknown. However, there are certain seizure conditions that are more likely to experience nocturnal seizures, including:

• Juvenile myoclonic epilepsy
• Awakening tonic-clonic (grand mal)
• Benign Rolandic
• Landau-Kleffner syndrome
• Frontal Lobe Epilepsy

Seizures can be linked to:

• Unusual brain development
• Stroke
• Serious head injury
• Brain tumor
• Brain infection (meningitis or encephalitis)
• Reduced oxygen to the brain

Diagnosis

The most useful way to diagnose the type of seizure is an electroencephalogram (EEG). This records electrical activity in the brain. The EEG can record unusual spikes or waves in electrical activity patterns. Different types of seizures can be identified with these patterns.

When a patient is experiencing nocturnal seizures, a sleep study is often needed to diagnose the condition. The sleep study will require the patient to stay overnight at the hospital where their brain activity can be monitored during their sleep.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to look at where the seizures are happening in the brain. The scans can show scar tissue, tumors or structural problems in the brain.

Treatment

For many patients, correct treatment can lower or prevent seizures. In some cases, patients may not have any more seizures for the rest of their life.

Treatment is based on:

• The type of seizure
• Any underlying conditions
• How often seizures happen
• How severe the seizures are
• The patient's age
• The patient's overall health
• The patient's medical history

Anti-seizure (or anti-epileptic) medications can be very helpful. It may take a few tries to get the right medicine and dose. The doctor will watch for side effects to find the best treatment.

Surgery may be an option if medication can't control the seizures. A vagus nerve stimulator (VNS) is sometimes implanted and used with anti-epileptic medication to lower seizures. The VNS is a tool placed under the skin of the chest. It sends electrical energy through the vagus nerve into the neck and up to the brain.

Certain lifestyle changes may also be used:

• Special high-fat, low-carbohydrate diet (ketogenic diet)
• Getting plenty of sleep
• Avoiding certain triggers, such as lack of sleep

The staff at the Cedars-Sinai Epilepsy Program will work with each patient to determine the best treatment option.

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