Published: 18 Jun 2025

ICD9: 345.10      ICD10: G40.309      ICD11: 8A61.4Y

Nocturnal epilepsy, also known as night epilepsy, refers to seizures that primarily or exclusively occur during sleep.
It's not a distinct type of epilepsy in itself, but rather a characteristic of certain epilepsy syndromes or a feature of focal seizures that happen to manifest during the night.

Here's a breakdown of what's important to know about night epilepsy:

Key Features:

Seizures During Sleep: The defining characteristic is the occurrence of seizures while the person is asleep. This can range from subtle events to obvious convulsions.
Variable Presentation: Nocturnal seizures can present with different symptoms depending on the part of the brain involved.
Often Missed or Underreported: Because individuals are asleep, they may not be aware they are having seizures. Bed partners or housemates may notice unusual behaviors.
May Indicate Underlying Epilepsy Syndrome: Certain epilepsy syndromes are more likely to be associated with nocturnal seizures.
Potential for Increased Risk: Some nocturnal seizures can pose specific risks, such as sudden unexpected death in epilepsy (SUDEP).

Possible Signs & Symptoms:

Sudden Arousals: Waking up suddenly in a confused or frightened state.
Unusual Movements: Twitching, jerking, stiffening, or repetitive movements during sleep.
Changes in Breathing: Apnea (temporary cessation of breathing), snoring, or noisy breathing.
Bowel or Bladder Incontinence: Loss of control of bowel or bladder function during sleep.
Biting the Tongue or Cheek: Can be a sign of a tonic-clonic seizure.
Morning Symptoms: Headache, muscle soreness, fatigue, confusion, or a bitten tongue upon waking.
Injuries: Unexplained bruises, cuts, or other injuries found in the morning.
Unusual Bedding: Disheveled sheets, pillow out of place, or being found on the floor.

Causes:

Night epilepsy is not a cause in itself, but rather a symptom. The underlying cause is epilepsy, which can result from:

Genetic factors: Inherited predispositions to seizures.
Structural brain abnormalities: such as tumors, strokes, or malformations.
Head trauma: Brain injury from accidents.
Infections: Meningitis or encephalitis.
Unknown causes: In many cases, the exact cause remains unknown.

Epilepsy Syndromes Associated with Nocturnal Seizures:

Benign Rolandic Epilepsy (Benign Epilepsy with Centrotemporal Spikes - BECTS): Common in children, often with nocturnal seizures affecting the face and mouth.
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy (ADNFLE): A genetic form of epilepsy characterized by brief, often bizarre, motor seizures during sleep.
Other focal epilepsies: Focal seizures originating in other areas of the brain can also occur during sleep.

Diagnosis:

Detailed History: A thorough medical history, including the description of the events during sleep. Information from bed partners is crucial.
Electroencephalogram (EEG): Measures brainwave activity. A sleep-deprived EEG or an overnight EEG can be more helpful in capturing abnormalities.
Video EEG Monitoring: Continuous EEG recording with video monitoring to correlate brain activity with observed behaviors during sleep.
Brain Imaging: MRI or CT scans to look for structural abnormalities in the brain.

Treatment:

Treatment for nocturnal epilepsy is the same as for other forms of epilepsy and typically involves:

Anti-epileptic Drugs (AEDs): Medications to prevent or reduce the frequency of seizures.
Surgery: In some cases, surgery to remove or disconnect the seizure focus in the brain may be an option.
Vagus Nerve Stimulation (VNS): A device implanted to stimulate the vagus nerve, which can help reduce seizures.
Dietary Therapies: In some cases, such as with children, a ketogenic diet can be helpful.

Importance of Diagnosis and Management:

Accurate Diagnosis: Identifying the underlying cause or epilepsy syndrome is crucial for appropriate treatment.
Seizure Control: Effective seizure control is essential to improve quality of life and reduce the risk of complications.
Safety Measures: Taking precautions to prevent injuries during seizures, such as using bed rails or soft bedding.
Awareness and Education: Educating family members and caregivers about nocturnal seizures and how to respond appropriately.

If you suspect that you or someone you know may be experiencing nocturnal seizures, it is important to consult a neurologist or epileptologist (a neurologist specializing in epilepsy) for diagnosis and treatment. Don't hesitate to seek professional help; effective management is available.