Nocturnal Seizures: Case Report and Discussion

Nocturnal seizures are one of the major problems of epilepsy. They are not benign and can result in sleep disruption leading to daytime somnolence and concentration difficulty. The diagnosis and characterization of this condition is difficult because the episodes are seldom witnessed. Various studies have shown that treatment of these seizures results in improvement in sleep efficiency, decreased arousals and increases in REM sleep. The challenge to clinicians lies in differentiating nocturnal seizures from other paroxysmal night events.

This article discusses about nocturnal seizures and a typical case of nocturnal seizures in a child has been elaborated. Case report This is the case of Patient X. Patient X is a 6 year old African American male who presents after a witnessed episode of generalized seizure without motor activity but with unresponsiveness and a staring look which lasted for at least 5 minutes during night sleep. It is likely that Patient X also had 2 other episodes in the week leading to his presentation.

This was suggested by two bed wettings in the preceding week, which the patient’s mother stated was unusual for him. The morning preceding the seizure the patient’s mother experience difficulty in arousing him from sleep. Additionally, on the way home from school the patient’s mother reports that he fell to sleep in the car as usual but was again difficult to be awakened and his body had gone limp. The patient’s mother took him inside and tried to wake him by slapping his cheeks but this too was unsuccessful.

After several attempts at arousal the patient’s mother called 911 for assistance. On arrival at the hospital, it took the patient about 2 hours to come to his normal self. While waiting on the ambulance the patient began to come out of sleep and subsequently vomited two times and appeared confused. Examination also revealed a mild right hemiparesis with a reduction of tone and reflexes consistent with a post–ictal state. An EEG was ordered and revealed moderate generalized abnormalities consistent with a seizure diathesis.

Following diagnosis, the patient was started on Tegratol to be built up over time to 300g/day to manage the seizures and a nascent nasal spray for his allergies. A complete blood count was ordered as well as SGPT and tegretol level to be taken at the end of one week. During a seven year period the patient was switched to 1200mg of Trileptal which was able to control his seizures. Notably the patient was seizure free for 7 years and on his last examination at age 15 he showed to have an improved only a mildly abnormal EEG showing diffuse sharp but slow waves during sleep.

This was likely due to his compliance with his medicaton. He had no new complaints and continued to be doing well academically and socially. He had 3/3 memory, normal blood pressure and pulse, speech and eye contact. His cerebellar system including cranial nerves II-XII remain intact and he still maintains mild right sided weakness and slight hyper-reflexed on his right side. He was directed to remain on trileptal and his trileptal levels are to be monitored and his bi-annual neurological check-ups maintained.

Records also indicate that at age 4 Martin was seen for headaches of a vaguely described nature which had persisted over a 4 month period. Examination at that time was found to be normal except for some increased activity and decreased attention. Patient X was found to be functioning within the healthy cognitive range for his age group and experienced no disruption in academic or social activities during the onset of headaches.

Physical examination in a patient who has just recovered from a paroxysmal event may hint at the diagnosis. In case of Patient X, physical examination revealed mild right hemiparesis with a reduction of tone and reflexes consistent with a post–ictal …

At that examination Patient X showed no focal deficit however, due to the relatively short duration of the headaches and age of onset an E. E. G was ordered to investigate the paroxysmal activity as well as an MRI to …

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