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The disorder where convulsions occur only when a person is sleeping is called nocturnal epilepsy. There are different types of epilepsy which are associated with nocturnal convulsions, of which epilepsy of the frontal lobe is an example.

Nocturnal convulsions will occur either when a patient is sleeping or during a time when a person should be sleeping. in other words, if a person is still awake during hours when they should be sleeping, they they would experience convulsions when awake. It's therefore imperative that the affected individual maintain a regular sleeping pattern. If one diverts from their normal sleep routine, then this can result in more frequent symptoms of epilepsy in patients with this issue, even when they are awake.

Type

Patients who suffers from nocturnal epilepsy can be categorized into two different groups. They are:

  • Generalized epilepsy - where there is generalized increased electrical activity throughout the entire brain.
  • Partial epilepsy - the increased electrical activity occurs in a regional or localized area of the brain. Here, convulsions can occur conversely in one part of the brain or several parts at once.

Symptoms and post-convulsion observations

Patients who experience nocturnal seizures might notice unusual issues when they wake up the following day. They may include the following:

  • Headaches.
  • Having bitten their tongue.
  • Having accidentally wet the bed.
  • Lightheadedness.
  • Weakness or fatigue.
  • Muscle strains.
  • Sustained a joint or bone injury.
  • Mental behaviors which are unusual and which are consistent with those that occur after a convulsion.
  • Patients may also find that objects have been hit down or that they themselves have fallen to the ground.

Diagnosis

Nocturnal epilepsy may be difficult to diagnose since the patient may not be aware they have a seizure disorder. The diagnosis of epilepsy is made with the help of others who describe the patient's symptoms, but in this case, the involuntary movements made by the patient might not appear different from those during normal sleep. 

Complications

Many risks are associated with nocturnal convulsions which may include suffocation, concussion and even a sudden, unexpected death in epilepsy (SUDEP).

Treatment

Nocturnal epilepsy is treated the same way any other form of epilepsy is, with anti-convulsant medication.

A catch-22 situation though can occur when treating nocturnal epilepsy. Certain anti-convulsants seem to disrupt people's sleeping patterns which, as mentioned, is a potential trigger for nocturnal convulsion to occur. Doctors are then faced with the issue of having to prescribe medication which will decrease the incidence of convulsions, but also having to make sure that it won't disturb the patient's sleeping patterns.

Therefore, in order to reduce the risk of convulsions in these patients, it's important that medication that doesn't affect the patient's sleeping cycle is prescribed. The medications which were tested and found to be appropriate are the following:

  • Phenytoin
  • Phenobarbital
  • Valproate
  • Carbamazepine
  • Gabapentin
  • Ethosuximide
  • Lamotrigine
  • Felbamate
  • Vigabatrin
  • Levitiracetam
  • Topiramate 
  • Zonisamide
  • Tiagabine
  • Oxcarbazepine. 

Oxcarbazepine was discovered to produce the safest effects on the patients' sleeping patterns. In another study, it was found that this medication enhances the patient's sleep continuity.

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