A neurological disorder that disrupts normal brain activity, causing sudden seizures and uncontrolled disturbance in a person’s brain, is known as epilepsy. On rare occasions, epilepsy occurs alongside another nervous condition that affects the brain and is known as narcolepsy. Epilepsy and narcolepsy share some similar symptoms. These symptoms may get worse for those who have both disorders. The comorbidity of epilepsy and narcolepsy significantly impacts the victims diagnostic and treatment procedure.
In this article, we are going to explore the connection between the two brain disorders, along with the ways to manage them.
As epilepsy and narcolepsy both affect the brain you can hardly find the difference. They share some symptoms but still they’re somehow different neurological conditions with distinct hallmark symptoms.
Sometimes, you may get confused and fail to distinguish the two. Here, you can understand their difference by keeping in mind that although both involve irregular brain activity, epilepsy causes seizures while narcolepsy is a disruption sleep-wake cycle. In addition, both neurological conditions can coexist, however, the coexistence is rare. There is a rare type of narcolepsy that also causes seizures similar to epilepsy, which often leads to misdiagnosis of epilepsy. Through this article you can take a closer look at each disorder, causes, similar and different symptoms and their treatment options.
How the Link between Epilepsy and Narcolepsy Can be Explained?
Epilepsy and narcolepsy both involve neurological disturbances that lead to episodes, resembling a loss of control or consciousness. However, health experts have explained that the mechanism influencing them is differ. They said that epilepsy is associated with various factors that disturb typical brain functions while they associated narcolepsy with a deficiency of a chemical messenger, known as hypocretin.
The overlapping symptoms of both neurological conditions make it challenging for the doctors to diagnose them accurately. However, research has reported that the origins and major symptoms of both are distinctively different from each other.
What is Epilepsy?
Epilepsy is an irregular activity of your brain in which the brain cells send signals to your muscles and other parts of the body in an atypically rapid and chaotic fashion. These chaotic signals lead to seizures often, which involves uncontrolled muscle movements but it also can affect your behavior, mood and the way you process different senses.
Studies suggest that about 1 in 36 people experience epilepsy symptoms.however, the condition often accompanies with other disorders, including:
- Stroke.
- Traumatic brain injury.
- Autism.
- Alzheimer’s disease.
- Cerebral palsy.
What is Narcolepsy?
Narcolepsy is usually referred to as extreme daytime sleepiness (EDS). This is the condition when people fall asleep suddenly without warning or feeling tired throughout the day regardless of how well you slept the night before.
Studies show that narcolepsy affects a large number of people in the country. The condition interferes with your brain’s regular sleep-wake cycle.
Moreover, researchers have concluded that this also resembles hypersomnia, a condition marked by extreme daytime sleepiness. A multiple sleep latency test is performed to make a definitive diagnosis for narcolepsy.
Medically, narcolepsy is subdivided into two types: type 1 and type 2. EDS is the main symptom of both types. However, those who have type 1 narcolepsy also experience a sudden loss of muscle control and muscle strength, known as “cataplexy”. Cataplexy further causes more injuries and falls.
Whereas, type 2 narcolepsy doesn’t include cataplexy and milder than type 1. It is more common than type 1.
Differences between the Symptoms of Epilepsy and Narcolepsy
People with epilepsy do not have sleep issues but narcolepsy is associated with EDS as a main symptom.
Similarly, seizures are associated with epilepsy but people with narcolepsy don’t experience this hallmark symptom or other prominent muscle control problems.
However, studies reported that some cases of type 1 narcolepsy were reported with cataplexy. In addition, muscle control or muscle strength problems sometimes end in seizure.
Epileptic people usually don’t remember having a seizure, but those who have narcolepsy remain fully conscious and remember all things that happen during cataplexy.
Similar Symptoms of Epilepsy and Narcolepsy
Epilepsy and narcolepsy share many symptoms, such as:
Disturbed Nighttime Sleep: Individuals with epilepsy may experience disturbed sleep due to nocturnal seizures that happen during sleep. Similarly, people with narcolepsy also have difficulty with fragmented sleep during the night.
Cognitive Challenges: Both neurological disorders affect the cognitive functions, leading decline in memory, attention and processing speed. These problems also occur due to sleep disturbances in narcolepsy or as a consequence of recurrent seizures in epilepsy.
Sudden Loss of Awareness: People with epilepsy or narcolepsy may experience episodes of sudden loss of awareness about their surroundings. In epilepsy it is called absence seizure while in narcolepsy this is known as sleep attack.
Daytime Sleepiness: In epilepsy, sleepiness follows a seizure or result from medication side effects while in narcolepsy, the sleep patterns get directly disrupted.
Brief Episodes of Muscle Weakness: Sudden brief muscle weakness due to strong emotions happens in cataplexy. However, some types of seizures also cause muscle weakness temporarily.
Causes of Epilepsy
Various causes involve in occurrence of epilepsy, such as:
Infections: Some parasitic infections, and brain infections like encephalitis and meningitis cause epilepsy.
Stroke: Disruption in blood supply to the brain results in strokes, which are harmful for brain tissues. This may lead to epilepsy especially in older adults.
Genetic Disorder: Inheritance of certain genes associated with increasing risk of seizures can trigger epilepsy.
Parasitic Infections: Parasites cause certain infections in the brain that can lead to epilepsy.
Brain Trauma: Accidents or falls sometimes injure the brain parts, these brain traumas lead to epilepsy.
Autoimmune Disorders: When the body’s immune system mistakenly attacks healthy brain cells, the condition is referred to as autoimmune disorder, which is the major cause of epilepsy.
However, still the cases are reported where the exact origin of epilepsy remains challenging. When the actual cause of epilepsy is unclear, healthcare professionals categorize it as idiopathic epilepsy.
Causes of Narcolepsy
The exact and accurate cause of narcolepsy is still unclear. However, some researchers have explained to some extent that narcolepsy involves the combination of genetic predisposition and environmental factors. Studies also showed that an autoimmune princess can cause a significant loss of hypocretin-producing cells in the hypothalamus, which is the hallmark of the condition.
How to Distinguish Epilepsy and Narcolepsy?
Epilepsy is often misdiagnosed when the people actually have narcolepsy because there are many similarities between the two conditions. Sometimes, doctors would fail to identify the symptoms of the disorders in the patients who have both. For example, doctors sometimes mistake a person’s narcolepsy symptoms for those of epilepsy if they already have a history of seizures.
Therefore, differentiating between epilepsy and narcolepsy, doctors usually begin by conducting a physical examination and reviewing family and personal medical history. Studies also prefer several clinical tests used to diagnose the two conditions in a differential diagnosis
Differential diagnosis is a process of ruling out other potential causes of your symptoms and signs. Diagnostic process is incomplete if differential diagnosis is not done because it rules out other factors that can contribute to occurrence of symptoms, which usually include:
- Medications or other substances.
- Sleep disorders.
- Medical and mental health conditions.
Experts also recommend the following tests to diagnose narcolepsy and to distinguish between epilepsy and narcolepsy. These tests are:
Hypocretin Tests
The main factor to confirm before diagnosing the type of narcolepsy, doctors prefer to determine whether or not you experience cataplexy. Presence of cataplexy symptoms indicate narcolepsy type 1, nor experiencing this confirms the narcolepsy type 2.
If the diagnosis is in questionnaire form, you doctors may want to determine the level of hypocretin in your cerebrospinal fluid. Hypocretin is a chemical found in the brain that helps regulate sleep among some other functions. It is also known as orexin. Lower levels of hypocretin are usually found in narcolepsy type 1. This happens rarely in narcolepsy type 2.
Multiple Sleep Latency Test
MSLT is the standard test to diagnose narcolepsy and measure daytime sleepiness. This is the most valid medical test used to diagnose narcolepsy. MSLT also helps measure the time it takes for you to fall asleep (sleep latency) in a quiet environment during the day. This is known as daytime nap study. This is a full day test, comprising three or four scheduled daytime naps. Each 20 minute nap is separated with a two-hour break. During these naps, experts conduct MSLT to measure how long it takes for you to fall asleep. They may also check how quickly you enter rapid eye movement sleep after sleep onset.
Video Electroencephalogram
This is a specialized test, through which you are video-monitored while electrons are applied to your scalp to monitor your brain’s electrical activity. By combining these two components, your healthcare professional can observe abnormalities in your brain waves while you’re experiencing a seizure in real time.
Epworth Sleepiness Scale Questionnaire
A thorough medical history is a common way to diagnose narcolepsy or epilepsy. You are asked about symptoms of the condition. Neurologists and sleep specialists gather the information from your medical history that can help them determine if the condition is epilepsy or narcolepsy could be responsible for your symptoms.
They also ask you to fill out an Epworth Sleepiness Scale Questionnaire to know how likely you are to fall asleep during specific activities, like talking to someone, reading or sitting.
Treatment of Epilepsy and Narcolepsy
Treatment of epilepsy focuses on the control of seizures that is usually done through anti-epileptic medications. However, in severe cases doctors may recommend nerve stimulation therapy, surgery or other dietary changes if medications do not affect the seizures. Whereas treatment of narcolepsy aims to manage its symptoms, which is usually done through medications that are stimulant to combat daytime sleepiness and antidepressants for cataplexy. In addition, some lifestyle changes like planned sleep schedule and naps.
However, team experts may recommend a combination of medications and lifestyle management to help treat the symptoms of epilepsy and narcolepsy.
Specific Medications for Epilepsy and Narcolepsy
Medical research has suggested that a combination of the two most effective medications, modafinil and lamotrigine can help manage excessive daytime sleepiness and auto,mastic behaviors, often seen in the people with these conditions.
In addition, combination of sodium oxybate with anti-epileptic medications can help manage cataplexy. Studies show that these medications are safe to use and also effective for the people with these disorders.
More Therapies for Epilepsy
Alongside medications, some more therapies may also help manger the symptoms of epilepsy, including:
Deep Brain Stimulation
This therapy involves implantation of electrodes into the different parts of the brain, especially in thalamus. A generation is also implanted in the chest or skull to transmit electrical signals to the brain. This procedure helps potentially reduce the number of seizures a person experiences.
Epilepsy Surgery
When the medications don’t work for management of epilepsy, doctors suggest surgery to remove the area of the brain responsible for the seizures.
Other Therapies for Narcolepsy
Following therapies are recommended by the doctors to help manage symptoms of narcolepsy:
Cognitive Behavioral Therapy
This form of therapy helps people with narcolepsy manage behaviors related to trigger cataplexy, sleep patterns, manage anxiety and control stimuli. This is a psychotherapy that can help treat narcolepsy, in addition to medications.
Moreover, people with narcolepsy are also at a higher risk of developing symptoms of anxiety and depression and their associated symptoms.
Maintaining Sleep Hygiene
Neurologists and sleep specialists unanimously agree to recommend people with narcolepsy to practice the following sleep hygiene as much as possible:
- Keep your sleeping space calm, comfortable and maintain a cool temperature.
- Stick to a regular sleep schedule with a perfect circadian rhythm.
- Avoid heavy meals, caffeine or alcohol before bedtime.
- Take some time for rest before bedtime.
- Take short naps when you feel tired during the day.
- Avoid smoking, especially near bedtime.
- Exercise regularly for at least 30 minutes.
Conclusion
Epilepsy and narcolepsy are two distinct neurological disorders with their own specific symptoms, causes and treatment options. Although both share some similarities in symptoms but still can be distinguished by effective means of diagnosis. They can co-occur but it’s rare.
Epilepsy diagnosis may occur during childhood, or at any age when you experience a first seizure. Narcolepsy can be diagnosed due to the signs of ESD.
Understanding each condition, recognizing their similarities and differences and seeking adequate medical assistance can help manage the symptoms of the two conditions and avoid severe complications.
