Nocturnal Seizures: Everything You Need to Know

Seizures occur when there is unusual electrical activity in the brain. Nocturnal seizures occur while a person is asleep. Since nocturnal seizures occur while a person is in a state of sleep, diagnosis can be challenging, especially if no one is present to observe them.

This article reviews the causes, symptoms, diagnosis, treatment, and prevention of nocturnal seizures.

Causes

Seizures are caused by abnormal electrical activity in the brain.

There are several possible reasons why people have seizures. Causes often depend on someone's age and medical history. But in about half of people who have seizures, there's no clear explanation.

Although the cause of nocturnal seizures is often unknown, some seizure conditions are more likely than others to occur while sleeping. These include:

• Juvenile myoclonic epilepsy: Seizures that start during childhood and are characterized by sudden, unintended muscle contractions
• Awakening tonic-clonic seizures: A seizure that occurs upon waking from sleep, causes uncontrolled jerking and stiffness of the arms, legs, or body
• Benign rolandic epilepsy: A seizure disorder that affects young children and adolescents
• Landau-Kleffner syndrome: A rare speech, language, behavioral, learning, and seizure syndrome that affects young children
• Frontal lobe epilepsy: A common form of epilepsy that stems from brain cells sending abnormal impulses in the frontal lobe

Symptoms

Many who experience nocturnal seizures do not know they have them. Symptoms of nocturnal seizures are often harder to identify because the people who experience them are asleep.

Epileptic seizures can occur at any time while a person is awake or asleep. Research has shown that approximately 20% of people with epilepsy only have seizures during sleep, 40% only have seizures while awake, and 35% have seizures both while awake and asleep.

Nocturnal seizures most commonly occur:

• Right after falling asleep
• Right before waking
• Right after waking
  

Signs that may indicate that a person has had a nocturnal seizure can include:

• Tongue biting
• Loss of bladder control and bedwetting
• Headache or bruises upon waking

Seizures during sleep may also cause involuntary movements, such as:

• Body jerks
• Stiff arms
• Stiff legs
• Crying out or making unusual noises
• Falling out of bed

Following a seizure, people can also be very hard to wake. They may also appear confused and be sleepy the next day.

Diagnosis

The most helpful way to diagnose nocturnal seizures is to have an electroencephalogram (EEG). An EEG is a test that monitors electrical abnormalities and activity in the brain. This painless procedure involves pasting tiny electrodes connected to small wires to the scalp. These electrodes can monitor the brain's activity while awake and asleep.

Sleep studies are also commonly done for people who suspect they may be having nocturnal seizures. This study requires an overnight stay to monitor electrical activity in the brain during sleep.

Following a seizure diagnosis, additional brain imaging may be taken to examine the brain areas that are affected by seizures. The imaging may include:

• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan

Treatment and Prevention

There are a few treatments that are known to help prevent seizures.

Antiepileptic Medications (AEDs)

Antiepileptic medications are usually the first treatment for seizures. They can effectively treat symptoms, but they do not cure the underlying condition that is causing the seizures to occur. AEDs work by slowing excessive abnormal electrical signals.

Ketogenic Diet Therapy

Ketogenic diets are the most common diet therapy used for people who suffer from seizures.

A ketogenic diet is a high-fat, high protein, and low carbohydrate diet. This diet may reduce seizures in many patients with difficult-to-manage seizures and some who don't respond well to AEDs.

Surgery

When AEDs and diet therapy aren't providing relief from seizure activity, surgery may be considered. Epileptic surgery involves removing a portion of the brain that's causing seizures to occur.

The goal of epilepsy surgery is to reduce or eliminate epileptic seizures. Some procedures could potentially completely stop seizures for many years.

Summary

Seizures result from abnormal electrical activity in the brain. Although the cause of seizures is often unknown, some seizure conditions are more likely than others to occur while sleeping. Many who experience nocturnal seizures do not know they have them.

Some symptoms may include tongue biting, loss of bladder control, headaches upon waking, or involuntary movements. Nocturnal seizures can be diagnosed through an EEG or sleep study. The most common treatments include antiepileptic medication, ketogenic diet therapy, and surgery.

A Word From Verywell 

Nocturnal seizures can be frustrating and significantly impact a person's quality of life. Fortunately, there are healthcare professionals, treatments, and other resources that can help. If you or a loved one has nocturnal seizures, contact a healthcare provider or sleep specialist to discuss treatment and prevention.