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Overview 

Epilepsy is a neurological condition that is associated with abnormal electrical impulses in parts of or the entire brain and leads to periods of abnormal behaviours and sensations, as well as loss of awareness or sudden muscle spasms or rhythmic contractions of the muscles. 

Nocturnal epilepsy is a disorder where seizures occur only while the affected individual is sleeping. The seizures may also occur at the time when the patient should be sleeping but is still awake at that time of night.

Therefore, having a proper sleeping-pattern is very important in these patients as this will reduce the risk of developing a seizure while awake. 

Types 

Patients who are known with epilepsy, whether it is nocturnal or not, can be categorized as having either generalized or partial epilepsy.

Generalized epilepsy, which is an inherited condition and therefore has a genetic basis, involves overall hyperactivity in the brain where electrical discharges occur at the same time over the organ all at once.

Partial epilepsy, on the other hand, affects a localized area or region of the brain meaning that seizures affect only that area or several different parts of the brain at once.

Diagnosis 

Nocturnal epilepsy may be difficult to diagnose because since the seizures occur at night, the affected individual may be unaware that they are actually experiencing seizures. Even others who are observing the patient sleeping may find that the involuntary movements they make as a result if the seizures may seem like those normally made during sleep.

The condition may be suspected when these individuals wake up in the morning and find that they have unusual symptoms and signs such as headaches, having bitten their tongues, having wet themselves and the bed, or having sustained soft tissue or even muscle or bone injuries. 

Others may observe abnormal mental behaviours that are consistent with what occurs in patients after experiencing a seizure. Objects around the bed may also be damaged or strewn around the room or the patients may unexpectedly find themselves lying on the floor.

Once the patient has consulted with their primary care doctor, they will be sent for further investigations such as a sleep EEG (electroencephalogram) where their brain activities will be monitored while they sleep. Abnormal brain waves consistent with those that occur during seizures while the individual sleeps will confirm the diagnosis of nocturnal epilepsy.

Management

Like many other forms of epilepsy, nocturnal epilepsy is managed with the use of anticonvulsant medications.

Although these are useful medications that help to reduce the risk of seizures experienced by patients diagnosed with nocturnal epilepsy, the drugs are noted to negatively impact the individual's sleeping patterns.

It is therefore important that patients are prescribed anticonvulsant medications that won't disturb these patient's sleeping patterns. 

The following are anti-epileptic drugs that are proven to help reduce seizure episodes in these patients as well as protect their sleeping structures:

  • Phenytoin
  • Phenobarbitol
  • Valproate
  • Carbamazepine
  • Ethosuximide
  • Gabapentin
  • Topiramate
  • Vigabatrin
  • Levetiracetam​
Oxcarbazepine is also shown to be an effective treatment for nocturnal epilepsy and has been demonstrated to have the least amount of adverse effects on sleep.

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