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Seizures While You Sleep?

Posted Aug 24 2008 1:49pm
ANNOUNCER: Epilepsy, or the condition of experiencing chronic, unprovoked seizures, affects approximately 2.7 million Americans of all ages. Epilepsy encompasses a wide variety of seizures that can be caused by many factors. One area of concern is seizure activity during sleep.

CARL BAZIL, MD, PhD: Sleep-related epilepsy would be those seizures that have a relationship with sleep. Some of them will occur predominantly during sleep, and sometimes they will occur exclusively during sleep. There are also conditions where the seizures almost or exclusively occur during the transition between sleep and wakefulness.

ANNOUNCER: The relationship between sleep and seizure activity is not well understood by physicians. But research has helped physicians begin to put pieces of the puzzle together.

CARL BAZIL, MD, PhD: Seizures occur because of groups of brain cells that are firing synchronously. Brain cells are supposed to be doing their own business most of the time, but if they pick up an abnormal signal, they might start all firing together, and that's what forms a seizure.

The same sort of condition happens during normal sleep. There are patterns during sleep where neurons tend to fire together in rhythmic patterns, and it may be that that underlying pattern makes it easier to have a seizure, but we don't really know.

ANNOUNCER: Sleep-related epilepsy occurs in a minority of epilepsy patients, anywhere from 10 to 25 percent, although because the patient is asleep, seizure activity is difficult to recognize. The patient may feel tired and fatigued during the day and not know why. Or the physician may recognize a pattern of sleep deprivation symptoms occurring over weeks or months. But there are a few techniques physicians and patients can use to diagnose sleep-related epilepsy.

STEVEN KARCESKI, MD: The initial step in diagnosing seizures that are associated with sleep is in the doctor's office. The person experiencing the seizures will explain a pattern of seizures that may occur, but medical testing can help to confirm this. Video EEG monitoring, which combines video and brainwave testing, capturing the person's seizures during sleep, is very helpful not only in establishing the diagnosis, but also in really focusing on the kind of seizure that the person is experiencing during sleep.

ANNOUNCER: If a patient suspects they are having seizures during sleep, it is important to address their concern with their physician for a number of reasons.

STEVEN KARCESKI, MD: There are very specific kinds of epilepsy where the seizures are more likely to occur while the person is sleeping. If this is a pattern of seizures that a person's been experiencing over a period of time, it's important to identify this and bring this to the physician's attention. The reason is that this information can be very important in helping to make the very specific diagnosis of the kind of epilepsy that that person has.

ANNOUNCER: It is also important to identify sleep-related epilepsy because lack of sleep, in and of itself, is a known cause of increased seizure activity.

CARL BAZIL, MD, PhD: One of the things that we worry about with sleep-related epilepsy is that patients can develop a vicious cycle. They become sleep deprived, they have more seizures, and seizures actually will cause sleep disruption. So they can get into this vicious cycle of seizures and sleep deprivation where it's impossible to completely control the seizures.

ANNOUNCER: Once sleep-related epilepsy is diagnosed, there are a large number of medications that can be effectively used.

CARL BAZIL, MD, PhD: Sleep-related epilepsy isn't that different from epilepsy in general. It's just that some seizures tend to happen during sleep, but they're all really treated the same.

Seizures that occur during wakefulness and sleep are both treated with anticonvulsants. And there's no real difference between the effectiveness of one and another. So we often end up choosing based on side effects.

Now, sedating effect is a very common side effect, and related to sleep, obviously. So medications such as phenobarbital and phenytoin (or Dilantin) are relatively sedating, and we tend to give them at bedtime. There are other medications like topiramate, zonisamide and lamotrigine, so that they can be alerting in some patients, and we give them earlier in the day.

ANNOUNCER: Dosing is also important factor when taking anticonvulsants for sleep-related epilepsy.

CARL BAZIL, MD, PhD: For instance, you might give a higher dose of medication at bedtime so that they're covered during sleep when they usually have their seizures, and so that they don't have so much medicine in their system when they don't need it, when they're awake.

ANNOUNCER: But probably the biggest cause of sleep-related seizures are undiagnosed sleep disorders.

CARL BAZIL, MD, PhD: Sleep disorders can have an impact not only on sleep-related epilepsy, but on epilepsy in general, because anything that causes a stress to the body can increase seizures.

We know that there are a lot of people out there who have undiagnosed sleep disorders. That can really be contributing to epilepsy and making it difficult or impossible to treat. So once the sleep disorder is diagnosed and treated, that's the only time the seizures can come under control.

ANNOUNCER: Over-the-counter and prescription sleep aids taken for sleep disorders can also potentially disrupt antiseizure medications, although most are safe and can be taken with anticonvulsants.

CARL BAZIL, MD, PhD: The one type of medication that you'd worry about in a person with epilepsy is benzodiazepines, like Valium, which is not used so much for sleep, but occasionally it is. Medications like Restoril; these can cause dependence over time, if they're used frequently. And when the patient stops them, the withdrawal phenomenon from that dependence can actually make seizures worse.

ANNOUNCER: With the increased focus on seizure activity during sleep, physicians and patients are better able to control seizures in general and improve a patient's quality of life.

CARL BAZIL, MD, PhD: Sleep-related epilepsy actually has a better prognosis than epilepsy in general. Most people with sleep-related epilepsy can become completely controlled. So if they're still having seizures on medication, reevaluation may be warranted to find out if they need additional medication, if they have a sleep disorder that's making their seizure worse. If those are found, then they have a very good chance of having complete control of their epilepsy.

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