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Suggest Treatment For Symptoms Of Nocturnal Seizure

Posted on Mon, 20 Jun 2016

Question: For the last week when I fall asleep I feel like I'm having a seizure. I begin shaking and feel like I am losing my grasp on life. I feel like I'm being electrocuted. I feel a surge of adrenaline and I wake back up panicked within seconds. It is most noticeable during the day, which has been happening for a couple of months. At night I take a small dose of klonopin and sometimes Ambien, so it happens less, but over the last few nights it is happening at night too. I felt like I was going absolutely crazy last night and stayed awake terrified.

Answered by Dr. Ishu Bishnoi (58 minutes later)

Brief Answer:
Consultation

Detailed Answer:
Hi XXXXXXX XXXX, thanks for asking from HCM.

I can understand your concern. You are experiencing psychological symptoms while going for sleep (occurring both in day and night). It could be

: Anxiety panic disorder
: Sleep phobia or somniphobia
: Sleep apnea
: Seizures (nocturnal seizures and daytime both)

I have given you probable list of differential diagnosis. We have to rule out one by one.
Seizures can be confirmed by

: EEG (Electroencephalogram) - You can consult neurologist for it. Seizures typically give spike wave discharges and can be easily identified. In your case, EEG monitoring during sleep is required along with 24 hour video EEG monitoring if any doubt.

: Sleep apnea can be confirmed by measuring in lab overnight sleep test. The doctor will monitor BP, respiration, pulse, oxygen saturation to know about sleep apnea.

After ruling out these pathological conditions, anxiety-panic disorder and sleep phobia can be differentiated by detailed history. Both conditions can be overlapped in you.

My advise is get your self evaluated and message me your reports. We can proceed further after it.

You are taking Lamictal and klonopin which act on seizures and anxiety both. Relief in your symptoms is due to their broad spectrum. What I personally believe, you are having anxiety-panic disorder along with sleep phobia.

I will provide you details of treatment after confirming diagnosis. Hope it will help you. Thanks.

Take care.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ishu Bishnoi (1 hour later)

Thank you very much! I have contacted my doctor and he wants me to schedule a sleep/neuro exam.

I am in-between psychiatrists. The symptoms have been worse since I discontinued Celexa, which one doctor thought was causing cyclothymia. I have a family history of bipolar and possible childhood trauma, both of which have similar symptoms but different treatments, no?

My dad experienced seizures after being on psych meds (lamictal included) for much of his adult life. In your opinion, can long-term lamictal/Antidepressant/antipsychotic using and frequent regimen/dose changes cause seizure symptoms?

Answered by Dr. Ishu Bishnoi (8 hours later)

Brief Answer:
Drug which can cause seizures

Detailed Answer:
Hi XXXXXXX XXXX, welcome back.

I got your point. Bipolar illness and childhood trauma aggravating it or leading to separate psychological manifestation like post traumatic stress disorder/altered personality. Now in your case, symptoms are overlapping between anxiety-panic disorder causing nigh terrors and post traumatic stress disorder (PTSD) causing night terror, not between bipolar and PTSD.

Treatment for PTSD and anxiety is different but overlap. So after confirming diagnosis, it can be properly treated. Let us wait till your complete sleep/neuro examination.

Answering your second question, Lamotrigine does not induce seizure as it is an anti-seizure medication (anti epileptic). But regarding antidepressants or antipsychotics, they can induce/aggravate seizures.

Hope it will help you. Thanks. Take care. If any doubt, do let me know.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ishu Bishnoi (2 days later)

I have a sleep neurology appt for the end of July. I haven't taken any day time naps but the nighttime disturbances have curbed in the last day or so.

Last week I had been taking ritalin on a more regular basis. We are talking 5-10 mg ER at the most per day. Things seem to have gotten worse after the last day I took a full 10mg. I have both bipolar and schizophrenia in my family (I think I touched on that above) could this be triggering psychotic or manic response? I haven't taken any this week.

my diagnosis has been so fluid, and we are struggling to get medication right. This might be useful in a differential diagnosis.

Thank you.

Answered by Dr. Ishu Bishnoi (9 hours later)

Brief Answer:
Consultation

Detailed Answer:
H XXXXXXX XXXX, welcome back.

The symptoms you mentioned above did not match with schizophrenia. Regarding bipolar illness, the manis usually manifests as over activeness, talkativeness, aggression, trying to do multitasking, impaired judgement, overconfidence. It is not related with sleep. These symptoms mostly occur in daytime. During sleep, patient remains normal.

However, it is good that you have mentioned this point. Because while prescribing medication to you, the doctor has to keep in mind that medication should be such that it does not cause precipitation of bipolar or schizophrenia.

Regarding Ritalin tablet use, it can cause side effects which resemble your symptoms like
chest pain, trouble breathing
seizure
hallucinations (seeing or hearing things that are not real), new behaviour problems, aggression or hostility
numbness, pain, cold feeling, unexplained wounds, or skin color changes (pale, red, or blue appearance) in your fingers or toes;
muscle twitches (tics);
unexplained muscle pain or tenderness
feeling nervous or irritable
sleep problems (insomnia)
loss of appetite
nausea, stomach pain
headache.

So consult your doctor regarding discontinuation of this drug or tapering its dose. Hope it will reduce your symptoms.

Thanks. Take care. Do let me know, if you have any doubt.

Above answer was peer-reviewed by : Dr. Raju A.T