Morning Seizures: Epilepsy or Other Neurological Issues?

Morning seizures

Hello, I would like to ask about my wife, who is 30 years old and had two generalized seizures while sleeping half a month ago, leading to a diagnosis of epilepsy.
Currently, all tests show no abnormalities.
She has been taking medication in the morning and evening, but a few days after being discharged, she started experiencing abdominal tightness and cramping, as well as stiffness in her lower back, occurring between 6:00 and 8:00 AM.
These symptoms last about half an hour to two hours and resolve on their own while she remains conscious.
Has this also been related to epileptic discharges? This has been happening for a week now.
The only way to alleviate the symptoms is to walk for about 10 minutes before the cramping starts or to take pain medication.
Could this also be a form of stiff person syndrome?

Huang, 20~29 year old female. Ask Date: 2023/01/14

Dr. Jiang Junyi reply Neurology

Hello Mr.
Huang,
You mentioned that "my wife experiences abdominal tightness and cramping between 6:00 and 8:00 in the morning." This is not a symptom of ankylosing spondylitis.
It resembles symptoms of localized cortical discharges.
May I ask if this occurs before taking her morning medication? Also, could you let me know the dosage of her antiepileptic medication? I suggest considering a change to an 8-hour dosing schedule to see if the drug concentration in her blood is unstable.
If the symptoms persist, it may be necessary to add a second medication.
Symptoms of epilepsy often fluctuate with the menstrual cycle.
I recommend a follow-up consultation in the neurology clinic.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2023/01/14

More Info

Hello, thank you for your question regarding your wife's recent health issues. It sounds like a challenging situation, and I appreciate your concern for her well-being.
Your wife has been diagnosed with epilepsy after experiencing two significant seizures during sleep. It's important to understand that epilepsy can manifest in various ways, and the symptoms can vary significantly from person to person. The fact that she has been prescribed medication (likely an antiepileptic drug) indicates that her healthcare provider is taking her condition seriously and aims to manage her seizures effectively.

Regarding the abdominal tightness and back stiffness that she experiences in the morning, it's essential to differentiate between symptoms that may be related to her epilepsy and those that could be indicative of another condition. The timing of these symptoms—occurring between 6:00 AM and 8:00 AM—could suggest a few possibilities.

1. Postictal State: After a seizure, individuals often experience a postictal state, which can include confusion, fatigue, and sometimes physical discomfort. However, since your wife is aware and alert during these episodes, it may not be directly related to her seizures.

2. Muscle Tension or Spasms: The tightness and stiffness in her abdomen and lower back could be due to muscle tension or spasms. Stress, anxiety, or even sleeping in an awkward position can lead to muscle tightness, which might explain the discomfort she feels upon waking.

3. Gastrointestinal Issues: The abdominal discomfort could also be related to gastrointestinal issues, such as gastritis or irritable bowel syndrome (IBS). These conditions can cause cramping and pain, particularly in the morning when the body is transitioning from a fasting state during sleep to waking.

4. Neurological Concerns: While it’s less likely, the symptoms could also be related to her neurological condition. Conditions like stiffness or spasms could potentially be linked to her epilepsy, especially if there are underlying neurological issues.
5. Other Conditions: You mentioned the possibility of stiff person syndrome or other neurological disorders. While these are less common, they can cause significant muscle stiffness and spasms. However, a thorough evaluation by a neurologist would be necessary to explore these possibilities.

Given that the symptoms resolve with movement or pain relief medication, it suggests that they may not be directly related to her epilepsy but could be a separate issue. However, it is crucial to discuss these symptoms with her healthcare provider, as they can provide a more comprehensive evaluation and determine if further testing is necessary.

In summary, while the abdominal and back symptoms your wife is experiencing could be related to her epilepsy, they may also stem from other causes such as muscle tension, gastrointestinal issues, or even a separate neurological condition. It is essential to maintain open communication with her healthcare team to monitor her symptoms closely and adjust her treatment plan as necessary. Regular follow-ups and possibly a referral to a specialist, such as a neurologist or a gastroenterologist, may be beneficial in addressing her concerns comprehensively.
I hope this information helps clarify your wife's situation, and I wish her a smooth recovery and management of her condition. Please feel free to reach out if you have any further questions or concerns.

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