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Understanding Nocturnal Seizures

Posted on October 25, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Amy Isler, RN

Seizures that occur during sleep are called nocturnal seizures. About 12 percent of people with epilepsy also have seizures during sleep, when they are falling asleep, or when they are waking up.

Nocturnal seizures have similar symptoms to parasomnia, an unpleasant or undesirable behavior that only occurs during sleep. These similarities can include sleep terrors and sleepwalking. Medical professionals can usually distinguish between the two by taking a detailed medical and family history.

What Seizures Are Common at Night?

Whereas nocturnal seizures can occur with any type of seizure disorder, some types of seizures are at an increased risk of occurring while you sleep.

Juvenile Myoclonic Epilepsy

Juvenile myoclonic epilepsy, also known as Janz syndrome, is a seizure disorder that typically begins in the teenage years and can progress into tonic-clonic (grand mal) seizures in adulthood.

This type of seizure usually causes quick jerking movements of the neck, shoulders, and upper arms. Because juvenile myoclonic seizures are so quick, these seizures may go undetected or be confused with clumsiness or tics.

Awakening Tonic-Clonic (Grand Mal) Seizures

Tonic-clonic seizures, also known as grand mal seizures, cause whole-body muscle contractions and a loss of consciousness. Grand mal seizures are the most common type of generalized seizures.

These seizures typically last from one to three minutes. Any seizure lasting more than five minutes is considered a medical emergency.

Benign Rolandic Epilepsy

This type of epileptic seizure is also known as childhood epilepsy with centrotemporal spikes (CECTS). Benign rolandic epilepsy is named after the rolandic area of the brain, which controls movement. When CECTS occurs during sleep, it typically causes face twitching and can progress into a tonic-clonic seizure. These seizures may also be seen during daytime naps.

Landau-Kleffner Syndrome

Landau-Kleffner syndrome (LKS) causes seizures and difficulty with speech (aphasia). When people with LKS have nocturnal seizures, they typically have focal onset aware seizures (seizures only affecting one part of the brain), but these seizures can also progress to tonic-clonic seizures.

Frontal Lobe Epilepsy

Frontal lobe epilepsy is a type of seizure that commonly occurs during periods of non-rapid eye movement sleep. The seizures are usually brief and clustered (happening close together). Symptoms of frontal lobe seizures include uncontrolled muscle movement, such as jerky movements or rigid arms and legs.

Symptoms of Nocturnal Seizures

Even though a person is not typically aware of having nocturnal seizures, they can disrupt sleep patterns. Sleep deprivation can lead to feelings of exhaustion and may even trigger more daytime seizure activity.

If you live or sleep alone, you might not know if you have experienced nocturnal seizures, but you may wake up to clues that something occurred during the night. These signs include:

  • Wetting the bed
  • Pain from biting your tongue
  • Having fallen out of bed
  • Tiredness and confusion
  • Unexplained bruising
  • Trouble concentrating
  • Awakening suddenly
  • Stiff arms and legs
  • Jerky movements
  • Night sweats

As a MyEpilepsyTeam member said, “Typically a nocturnal seizure happens shortly after I fall asleep, but there have been times when it has been midnight. I usually wake up after the seizure from being drenched in sweat.”

How Are Nocturnal Seizures Diagnosed?

If a neurologist suspects that you are having nocturnal seizures, they will typically perform a sleep study and an electroencephalogram. These tests help the doctor monitor your brain activity and detect any abnormalities. An MRI or CT scan may be necessary to pinpoint where in the brain the seizures are happening.

Treatment and Safety With Nocturnal Seizures

Treatment options for people diagnosed with nocturnal seizures depend on several factors, including:

  • Underlying conditions
  • Type of seizure
  • Severity of seizures
  • Age
  • Overall health
  • Medical and family history

Watch epileptologist Dr. Jonathan C. Edwards explain how nocturnal seizures can be treated.

Antiepileptic medications are often very effective at decreasing seizure activity. They may be prescribed to control both daytime and nocturnal seizures. In addition to medication, your doctor may also suggest lifestyle changes, such as:

  • Following a ketogenic (high fat, low carb) diet
  • Creating a consistent sleep schedule
  • Avoiding what triggers your seizures, including lack of sleep
  • Getting regular exercise
  • Avoiding recreational drugs and alcohol

If medication or lifestyle changes do not minimize your seizures, then epilepsy surgery may be necessary. Surgery may involve inserting a vagus nerve stimulator under the skin of the chest to help lower seizure activity with electrical energy.

Sudden Unexpected Death in Epilepsy

Because nocturnal seizures happen while you are sleeping, these seizures may go undiagnosed. Undiagnosed seizures can be dangerous because they may lead to sudden unexpected death in epilepsy (SUDEP) if not treated and controlled properly.

SUDEP occurs in more 1 in 1,000 people each year, according to the Epilepsy Foundation. Doctors believe that SUDEP is linked to nocturnal seizures that cause low blood oxygen levels (hypoxemia). Hypoxemia can lead to breathing disturbances and dysfunction in brain activity.

Safety

Worrying about nocturnal seizures can become stressful for you and those close to you. It is important to talk with the people you spend time with to let them know what to do in the event of a seizure. A seizure action plan can often be helpful for these conversations. An action plan is a document that outlines what to do in case of an emergency, including seizure first aid.

Several nighttime seizure monitors can also screen for excessive movement and alert you when they detect seizure symptoms.

Other safety tips to avoid injury during nocturnal seizures include:

  • Getting a low bed frame or putting the mattress on the floor
  • Placing a mat next to the bed in case you fall
  • Mounting bedroom lamps on the wall instead of placing them on a nightstand
  • Moving furniture and other items away from the bed

You’re Not Alone

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. More than 99,000 members come together to ask questions, give advice, and share their experiences with others who understand life with epilepsy.

Have you experienced nocturnal seizures? Share your experience or management tips in the comments below or by posting on MyEpilepsyTeam.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Amy Isler, RN is a registered nurse with over six years of experience as a credentialed school nurse. Learn more about her here.

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