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Medical Article

Sleeping Disorder and Epilepsy

Epilepsy

Epilepsy is a serious neurological condition where individuals with epilepsy tend to have recurrent seizures (fits).  The seizures occur due to a temporary disturbance in brain function in which a group of nerve cells present in the brain fire signals abnormally and excessively. The affected person will behave in unusual manner or will undergo strange emotions and sensations. They may undergo extreme muscle spasms or lose consciousness. 

There are various reasons for seizures; all of them are not due to epilepsy. It may happen due abnormal levels of blood glucose or sodium, brain infections and brain injury.  In most cases underlying causes are unknown.

Seizures in children occur very often. Older children are prone to different types of fits like tonic-clonic, absence, myoclonic. Epilepsy is different in each child, so needs an accurate diagnosis. It shows good response to antiepileptic drugs and help children to lead normal life.  Compared to the seizure of adult brain children’s seizure is more vulnerable, but the reason is unknown.

Causes of Epilepsy 

Many factors are associated with epilepsy, the exact reason remain obscure. It can be due to disruption of normal connections between the neurons or nerve cells in the brain. Either few cells overexcite or suppress other cells from transmitting messages or may be due to both the reasons.

Known causes of epilepsy are:

Causes of epilepsy vary with age of the person. Some people with no clear cause of epilepsy may have a genetic cause. The true fact for every age is that the cause is unknown for about half of everyone with epilepsy. 

Some of the known causes of epilepsy are –

Some people with no known cause of epilepsy may have a genetic form of epilepsy. The relationship between genes and seizures can be very complex and genetic testing is not yet available. 

The changes in the structure of brains cause the electrical storms of seizures. Some young children may be born with a structural change in an area of the brain that gives rise to seizures. 

Brain infection is a common cause of epilepsy. 

Severe head injuries cause epilepsy.

In middle age, strokes, tumours and injuries are most common reasons.

Treatment for epilepsy

Anti-epileptic medications: Up to 70% of people could have their epilepsy controlled with anti- epileptic medications. The medicines work by stabilizing the electrical activity of the brain. 

Ketogenic diet: It is a treatment option for children with epilepsy whose seizures cannot be controlled with medications. The diet helps to reduce severity of seizures.

Vagus nerve stimulation (VNS): VNS therapy is a type of treatment for epilepsy that involves a stimulator which is connected inside the body to the left vagus nerve in the neck. The stimulator sends regular, mild electrical stimulation to suppress irregular electrical brain activity that leads to seizures.

Epilepsy Surgery, it is brain surgery for epilepsy patient, to stop or reduce their seizures.

Deep brain stimulation is a surgical treatment to reduce seizures not controlled with medication or surgery. To control seizures implant electrodes in specific areas of the brain.

A corpus callosotomy, is also known as split-brain surgery, performed in people with the most extreme and uncontrollable forms of epilepsy, when frequent seizures affect both sides of the brain.

Epilepsy and Sleep Disorders

Epilepsy and sleep disorders go hand in hand. Seizures are very sensitive to sleep patterns, so careful balance is required.

Epilepsy and Sleep Apnoea

Sleep apnoea may exacerbate epilepsy by causing sleep disruption and deprivation, hypoxemia, and decreased cerebral blood flow. Sleep apnoea is a long-term disorder that disrupts the normal sleeping pattern. Poor quality of sleep makes the person tired full day and lead to day time sleepiness.

The lack of sleep triggers seizures in epileptic individuals. For some people the effects of having seizure can upset their sleep pattern for several days afterwards. Certain antiepileptic medication also disturbs normal sleep and cause daytime drowsiness. Improper sleep aggravates epilepsy. 

Epilepsy and Obstructive Sleep Apnoea

Obstructive sleep apnoea (OSA), where a person snores and then stops breathing for short periods during sleep, it is common in epilepsy patients. It may be caused by low muscle tone around the airway. It is mainly observed in males, obese people, smokers and individual of above 40 ages. OSA found in 10% in adult and 20% in children with epileptic problems. Untreated OSA lead to seizures, because both epileptic and OSA often co-exist. The treatment can reduce seizure and daytime sleepiness. 

Epilepsy and Restless Leg Syndrome

Patient with restless leg syndrome (RLS) complain of an unpleasant crawling or deep aching sensation in the legs that is improved by motion of the legs. It is a neurological disorder causing abnormal sensations in the legs, recently renamed it as Willis-Ekbom Disease (WED). Most individuals experience these symptoms while sitting or lying down and may complain of the need to walk or continuously move their legs, which reduces the discomfort. It can cause daytime sleepiness, short-temperedness and loss of concentration. This can lead to seizures in an epileptic person. RLS can be controlled voluntarily, but an epileptic seizure cannot be inhibited.

Sleep Paralysis and Epilepsy

Sleep paralysis is a temporary paralysis of the body just after the patient wakes up and just after the patient falls asleep. This condition persists up to 10 minutes or continues for half an hour. The condition is associated with medical condition like seizure disorders, mental health, narcolepsy and hypertension. 

Effects of Antiepileptic drugs on sleep

The connection between sleep and epilepsy are well known. Sleep disturbances such as drowsiness are among the most frequent side effects of treatment with antiepileptic drugs (AED), since it modify the sleep cycle. Many epileptic patients take antiepileptic drugs to control their seizures. Diurnal sedation and somnolence are common side-effect of AEDs. Drugs like Ethosuximide create night terrors and sleep disturbances, Gabapentin, Phenytoin, Rufinamide cause insomnia (inability to sleep), Lamotrigine cause insomnia, sleep disturbances, Topiramate create situations like  sleeping difficulty, Pregabalin can lead to strange dreams, insomnia, Phenobarbitone cause Daytime sleepiness, Carbamazepine create the problem of Sleep disturbances. 

Sleep deprivation and epilepsy

Sleep deprivation has long been recognized as a seizure precipitant, reported by up to one-third of patient with epilepsy, more often those with awakening epilepsy. Epilepsy disturbs normal sleep, and improper sleep aggravates it. It causes problems like daytime drowsiness, epileptic seizures, interictal epileptiform discharges and memory dysfunction. Treatment for sleeplessness can control seizures and also prevent daytime sleepiness.

 Tips for Good Sleep

Sleep is a basic human need; it is like eating, drinking and breathing. It is the vital part of the foundation for good health and well-being throughout your life. Follow few tips like this:

Try to go to sleep and get up at the same time every day, take regular exercise, Avoid sleeping in—even on weekends, keep the room dark when you got to bed, keep your mind relaxed and stress-free before bedtime, use comfortable pillows and mattresses, keep your room clean and free from bad odour, Say no to late-night television, Limit fluid intake before going to bed, to avoid night trips to the toilet, avoid alcohol, caffeine and nicotine immediately before going to bed.