Nocturnal Seizures in a Man with Coronary Disease

This chapter inspects the case of a man diagnosed with generalized tonic-clonic seizures precipitated by nocturnal hypoxemia caused by obstructive sleep apnea. The man experienced three episodes of generalized tonic-clonic seizures that occurred at 3.00 or 4.00 AM, during sleep. The seizures were observed by his wife. His mental status after each seizure was consistent with a postictal state. His neurological examination was unremarkable and nonfocal. He was subsequently found to have nocturnal hypoxemia caused by obstructive sleep apnea, which was ameliorated by treatment with continuous positive airway pressure (CPAP) during sleep. He was initially treated with phenytoin 400 mg/day in divided doses for control of seizures. CPAP used at night alleviated the episodic hypoxemia. He remained seizure-free for 1 year after discontinuation of phenytoin until he traveled to an altitude of about 2100 m and slept without using his CPAP machine. Obstructive sleep apnea is an under-diagnosed condition that is associated with severe health consequences. Although this diagnosis is sometimes suggested by a characteristic constellation of symptoms, many of the symptoms are nonspecific and easily disregarded by patients and their health-care providers. In some cases, seizures are the presenting sign of sleep apnea, as in this patient.