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American Journal of  
Chemistry and Pharmacy (AJCP)

A Rare Type of  Epilepsy: A Case Report
Ali Hassan Salman Nasser1*

Volume 1 Issue 2, Year 2022
ISSN: 2834-0116 (Online)

DOI: https://doi.org/10.54536/ajcp.v1i2.1053
https://journals.e-palli.com/home/index.php/ajcp

Article Information ABSTRACT

Received: December 05, 2022

Accepted: December 16, 2022

Published: December 23, 2022

Epilepsy is one of  the most frequent severe brain disorders, impacting about 70 million 
individuals globally. Its prevalence is bimodal, with neonates and the elderly suffering the 
highest risk. Whether using medications or not, nearly two out of  every three individuals 
suffering from new-onset epilepsy will achieve long-term seizures remission, although 
around half  will experience mild to moderately severe side effects. Patients with epilepsy, 
mainly the 20-30percent of  the respondents whose seizures are not fully controlled by 
present treatments (drug-resistant epilepsy), have a significantly increased risk of  death, 
mental and physical comorbidities, and severe pharmaceutical effects. Here we present a 
case of  56-year-old man who was admitted to a private hospital and diagnosed with a rare 
type of  epilepsy. He was unconscious, hence reported as comatose state. Mental diseases, 
such as depression, have also been predominantly studied in our patients, although there 
was a rising acknowledgment of  a bidirectional association between the epilepsy and depression. 
The patient has been introduced to pregabalin 75mg once to rouse from a comatose 
state. Following this regime, he was declared conscious and alive. He was discharged and 
continued to pregabalin 75mg daily until the next follow-up. Pregabalin was found to be a 
significant addition to the treatment of  epilepsy because of  its effective antiseizure action, 
favorable pharmacokinetic properties, and efficacy in frequent co-morbidities. Antiepileptic 
drug development must be resuscitated rapidly in order to identify new effective anti-seizure 
medications for the treatment of  drug-resistant epilepsy International health practitioners 
may continue the further investigation related to the onset of  this condition to reach 
significant evidence and treatment.

Keywords
Epilepsy, Obstructive 
Sleep Apnea, Depression, 
Hypersomnolence, Insomnia, 
Pregabalin, Case Study

1 AVP, Oman Insuransce Co Dubai, United Arab Emirates
* Corresponding author’s e-mail: AliHassan35S@outlook.com

INTRODUCTION
The choice of  whether or not to do a formal laboratory 
assessment of  the sleeping patient is crucial to the evaluation 
of  patients with sleep problems. Many of  the presenting 
symptoms may be related to different diseases that entail 
sleep disruption; however, much of  the information 
in this section focuses on the patient with respiratory 
irregularities during sleep. Though a more comprehensive 
system for categorizing sleep disorders has been devised 
and published elsewhere (Coleman et al., 1982; Thorpy, 
2012), the method used here is more streamlined and 
focuses on symptoms. Since there are more sleep labs 
available than ever before, this article will concentrate 

on how to recommend individuals who may be suffering 
from a sleep issue to one. Table 1 provides an exhaustive 
list of  symptoms experienced by individuals with sleep-
related breathing issues. In contrast, Table 2 provides the 
most prevalent signs that indicate sleep disturbance as 
the underlying cause. Patients with sleep disorders often 
have insomnia (trouble starting or keeping asleep) or 
excessive daytime drowsiness (hypersomnolence) (Bixler 
et al., 1979; Thorpy, 2012). Because of  the intertwined 
nature of  sleep and wakefulness, it is not uncommon for 
both of  these conditions to coexist. However, to treat 
either disease effectively, it is necessary first to identify 
whether insomnia or hypersomnolence is more prevalent. 

Table 1: Symptoms in Patients with breathing disorders during sleep
Major or Common symptoms 
Awakening from slumber (occasionally with shortness of  breath)
Abrupt cessations of  breathing (as reported by bed partner)
An excessive inability to stay awake throughout the day (hypersomnolence)
Screeching snores
Minor or less common symptoms
Sleep-related abnormal motor behavior
Insomnia

Table 2: Symptoms Suggesting Underlying sleeping disorders
Insomnia 
Hypersomnolence

Hypersomnolence 
Simply asking patients may diagnose pathologic daytime 
drowsiness if  they have experienced tiredness during 

typically awake activities like chatting or eating (Smith, 
1988). Sleepiness during sedentary activities like reading 
or watching television is a common symptom of  a 

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sleep disturbance in its early stages, but it may be easy 
to overlook. It is thus important to listen to the input 
of  loved ones who may have noticed a shift in the 
subject’s degree of  attention. Hypersomnolence differs 
from exhaustion, fatigue, or lethargy since those states 
do not automatically lead to drowsiness. The social 
shame and fear of  job loss sometimes lead individuals 
to conceal clinically obvious hypersomnolence (Smith, 
1988). Moreover, sleep apnea and other sleep disorders 
may cause cognitive impairment, reducing the individual’s 
sensitivity to tiredness. Therefore, it may be more 
important to assess how well a person sleeps than how 
well they can remain up when trying to provoke this 
symptom. Inquire as to whether or not you tend to nod 
off  when doing boring or repetitive tasks.
Many factors may lead to excessive sleepiness. Night-time 
sleep problems are the first cause of  daytime drowsiness 
because they alter the typical sleep pattern (Smith, 1988). 
Sleep disorders like sleep apnea or restless leg syndrome 
may drastically reduce restorative slow-wave sleep while 
boosting stage 1 sleep. The frequency of  simultaneous 
partial arousals, which may follow respiratory or 
movement abnormalities, is more significant than any 
changes in the distribution of  phases. A night of  sleep 
may be severely fragmented and shortened by as many 
as 300 to 500 arousals, each lasting 15 to 20 seconds. 
Despite the high frequency, patients are unaware of  a 
sleep disorder since the arousals do not lead to complete 
restlessness (Zarcone, 1973).

Insomnia 
Insomnia, which is not a diagnosis in and of  itself  
but rather a symptom complex defined by difficulty in 
beginning sleep, intermittent arousal from sleep, or early 
morning awakenings with an inability to return to rest, is 
another important presenting symptom of  individuals with 
sleep disorders. It is common to practice dividing insomnia 
into two categories: temporary and chronic (Thorpy, 2012). 
Insomnia that lasts just a few nights and is brought on by 
external factors that often pass on their own is considered 
transient or episodic. Psychophysiological stress is the 
leading cause of  temporary sleeplessness (Carskadon 
et al., 1976). Though sleep lab examinations often 
show normal sleep architecture, chronic or persistent 
insomnia is typically attributable to a chronic worry state 
(Carskadon et al., 1976).
Suppose a patient has real insomnia, as shown by 
decreased total sleep duration, fragmented sleep, or early 
morning awakenings. In that case, they will likely also have 
chronic weariness or lassitude but not hypersomnolence. 
Insomnia is common in patients who suffer from sleep 
apnea or movement problems because of  the numerous 
full awakenings that might occur as a result. The elderly 
may have a lower arousal threshold than younger patients, 
making it more difficult to fall asleep and stay asleep even 
when mild central or obstructive sleep apnea is present.
Similarly, to patients with hypersomnolence, endogenous 
and external stimuli may have tertiary effects on sleep. 

Insomnia and drowsiness throughout the day are 
common side effects of  serious medical conditions such 
as chronic pain, dyspnea, and others. However, normal 
sleep start with early morning awakenings and is more 
common among depressed people. Significant problems 
with falling asleep may also be caused by exogenous 
causes, such as stimulant drugs or substance usage.

Epilepsy 
Around 1% of  the population has epilepsy, making it 
the second most frequent major neurological illness after 
stroke (Stafstrom, 2006). About 50 million individuals 
worldwide have epilepsy, with 90 percent of  those 
affected living in poorer nations (Kandar et al., 2012). Our 
knowledge of  epilepsy has advanced in various ways during 
the last several years. It is a common chronic neurological 
condition characterized by repeated unprovoked seizures 
and an imbalance between brain excitability and inhibition 
(Blume et al., 2001; Holmes & Ben-Ari, 2001).
Keeping the thalamus and its cortical connections, 
the temporolimbic system, and the ascending reticular 
system in good working order is essential for maintaining 
consciousness. If  the ascending reticular system were 
damaged structurally or functionally, the patient would 
have severe abnormalities in their ability to quantify 
their surroundings or perhaps go into a coma. EEG 
patterns in a coma have been used to predict coma 
outcomes (Bauer et al., 2013) for decades and correlate 
to the degree of  consciousness impairment and the 
depth of  coma. However, the normal EEG patterns 
do not indicate a specific coma etiology (Synek, 1989, 
1990a, 1990b). These developments have led to a new 
taxonomy of  epileptic seizures and epilepsies. The 
diagnosis is founded on a thorough clinical history and 
a credible eyewitness description of  a seizure  (Thijs et 
al., 2019). Over the last decade, novel medicines for the 
treatment of  epilepsy have proliferated. With an ever-
expanding range of  possibilities, physicians must select 
which therapy, or combined effect of  interventions, is 
optimal for a specific individual. Despite the existence 
of  controlled scientific trials for each therapy option, the 
answers to these concerns may remain elusive(Leeman-
Markowski & Schachter, 2017; Thijs et al., 2019). Ancillary 
investigations can aid in the determination of  the etiology 
and prognosis (Stafstrom & Carmant, 2015). Therefore, 
we report a case of  a male who have suffered from a rare 
cognitive behavior that included epilepsy and depression 
with variables like insomnia, Obstructive sleep apnea, and 
Hypersomnolence. The combination of  such conditions 
have turned the case as rare.

Case Presentation 
A 56-year-old male, who is receiving treatment in a 
private hospital in the United Arab Emirates, suffers 
from a very strange condition for which the doctors did 
not find an explanation and considered it a very rare case 
in medical science. The patient’s chronic symptoms had 
a history of  depression during sleeping and he used to 

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take “Clonazepam gabapentin” to treat depression. The 
patient was also diabetic for which he takes “Metformin” 
750mg per day. History of  cardiovascular disease was 
also reported and “atrova STATIN” was used to treat 
congenital heart disease. Along with these medications, 
“Esomeprazole” was used to treat stomach acid 20mg 
once a day, “Ergocalciferol” one capsule per week 
was given to the patient that enhances VIT D level, 
“Neurobion” 100mg to enhance vitamin B complex and 
magnesium oxide 400mg once a day. 
The acute illness of  patient reported the onset symptoms 
5 years ago, which was worst on the right leg and worsened 
over time in the form of  mild irritability in the leg, causing 
difficulty in moving. He had difficulty and utility of  the 
feet in both legs, which was worsening during sleep and at 
times of  prolonged sitting. The abnormal leg movements 
started worsening, and he used to have wild flinging 
movements in sleep that resulted in fatigue and numbness 
of  the outer aspect of  the left thigh. The patient was 
started with SIFROL, Lyrica, and lidocaine to treat this 
condition, but no effect was measured. Due to this, the 
doctor advised shifting towards another treatment, i.e., 
“Pramipexole with gabapentin,” to treat the numbness 
and burning sensation and increased the dose of  Lyrica 
and lidocaine. Insomnia was also reported from the 
patient’s history, and “Zolpidem” was used to treat it, 
5mg once a day. No history of  difficulty of  gait or any 
dystonic posturing, no history session of  involvement of  
higher mental functions; cranial nerves, cerebellar system, 
autonomic nervous system.
At the time of  admittance, patient was unconscious 
for straight seven hours. No seizures were reported. 
According to the neurologist, this problem is not limited 
to his area of  expertise; as the patient experiences this 
condition four or five times a year. There have been no 
warning symptoms before the onset of  this condition; it 
occurred suddenly. Doctors in the emergency department 
take immediate measures to bring a comatose patient back 
to life, but no improvement was observed initially. The 
physician also implanted a needle into the patient’s body, 
used cold water and bits of  iron to contact the patient’s 
feet to rouse him. After ensuring that the patient’s vital 
organs are functioning correctly, he was taken to the 
medical imaging room for MRI & CT scan. The patient 
was neither dead nor alive; and merely “Attentive” to the 
movements and sounds in his immediate environment. 
After 7 hours, the patient spontaneously rouses from his 
coma, without the help of  any medical professionals or 
mechanical aids, and expresses a desire to be discharged; 
hence the patient was considered “Alive.” After regaining 
consciousness, the patient answered the basic questions 
correctly about his identity and present state. However, 
the patient remained silent when the doctor inquires 
about the events that transpired half  an hour before his 
loss of  consciousness. The patient was sent to a team of  
specialists, including a cardiologist, psychiatrist, oncologist, 
ENT, and pulmonologist. Moreover, the internal brain 
and nerves, and the result came from the doctors after the 

testing, from x-rays to medical tests, showed everything 
was normal. Since he was in unconscious state for 7 
hours, the neurologist prescribed him Antiepileptic drugs; 
Pregabalin and Lyrica. According to the neurologist, the 
condition of  unconsciousness could have been a possible 
reason of  a rare type of  epilepsy.

DISCUSSION 
From the investigation it is evident that patient has a rare 
type of  epilepsy. Nowadays, several safe antiepileptic drugs 
are introduced limiting the indications for depression and 
anxiety prescription. Despite the fact that there are safer 
ways to treat status epilepticus, the medicine has its own 
market. Increased chloride inflow and neural inhibition 
are hypothesized to be responsible for the antiepileptic 
effects of  the drugs through its impact on gamma-
aminobutyric acid (GABA) receptors. (Olsen et al., 1986). 
Depression is an under recognized yet prevalent 
comorbidity of  epilepsy. The identification of  mood 
disorders is the first and most crucial step in providing 
effective treatment for this group. Improved detection 
and treatment quality may be achieved by increased 
clinical attention and the regular use of  a validated 
screening instrument. People who have epilepsy, like 
the general community, are increasingly curious in 
complementary and alternative medicine treatments for 
persistent conditions like depression (Fenton & Udwin, 
1965). 
Epileptic disorders include Sleep disorders, such as 
narcolepsy (NRCLP), restless legs syndrome (RLS), 
and obstructive sleep apnea syndrome (OSAS), are 
increasingly thought to be influenced by a set of  inherited 
factors, and evidence for this is mounting (Caylak, 2009). 
Excessive daytime drowsiness, cataplexy, sleep paralysis, 
and hallucinations are characteristic symptoms of  
NRCLP. A common symptom of  RLS is an incessant 
itch to move one’s legs, which may make it difficult to 
fall asleep. Recurrent bouts of  upper airway collapse and 
blockage during sleep define Obstructive Sleep Apnea 
Syndrome (OSAS), a serious sleep disorder (Almbaidheen 
& Bodur, 2021).
However, the results of  our research imply that antiepileptic 
medicine pregabalin might be useful in the treatment 
of  individuals suffering from epilepsy, depression, and 
OSA. Pregabalin, the S-enantiomer of  3-aminomethyl-
5-methylhaxanoic acid, is an antiepileptic drug (AED) 
of  the second generation, developed after gabapentin, 
with enhanced pharmacokinetic and pharmacological 
properties. Pregabalin is a favorable therapy choice due 
to its rapid absorption, high bioavailability, and absence 
of  transporter saturation at therapeutic levels. More 
than ninety percent of  the drug is removed in the urine, 
and nearly none is metabolized by the liver. Pregabalin 
is believed to exert its antiepileptic action through 
modifying calcium channel traffic and physiology by 
binding to the 2 subunit of  P/Q-type voltage-gated 
calcium channels, hence reducing presynaptic calcium 
influx and neurotransmitter release (Hamandi & Sander, 

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2006; Schulze-Bonhage, 2013).
Currently, our group is conducting follow-up experiments 
to validate this rare case and to investigate the potential 
benefits of  antiepileptic medications. Moreover, the 
current scenario is also under study by international 
hospitals and medical professionals.

CONCLUSION 
It is generally agreed that epilepsy, with a lack of  clarity in 
its definition, is best understood as a transitional condition. 
The health professionals diagnosed our patient with a very 
unusual kind of  epilepsy. Our findings indicate a strong link 
between epilepsy, OSA, depression, and RLS. Moreover, 
medical researchers worldwide are also examining the 
present situation. In our case, Pregabalin has proven to be 
effective against epilepsy as it prevents seizures in epilepsy 
by lowering aberrant electrical activity in the brain. It 
suppresses the nerves pain by influencing pain messages 
traveling through the brain and down the spine. It prevents 
brain from producing the chemicals that cause anxiety. 
More antiepileptogenic drugs are also required to prevent 
epilepsy before the first seizure in at-risk individuals, as well 
as disease-modifying medications to treat persistent severe 
seizures associated with progressing underlying illness.

Acknowledgement
The author is thankful to the University of  Manchester, 
Saudi Arabia, for the continuous support of  this research 
study. 

Funding
No funding sources are reported.

Conflict of  Interest
The author does not have any conflict of  interest. 

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