1/20/2024 0 Comments Nocturnal epilepsy temporal lobe![]() ![]() non-familial) NFLE is rarely reported, in contrast to familial NFLE, and therefore is poorly understood. (3) Episodic Nocturnal Wandering (ENW) with duration of episodes lasting up to 1-3 min, for which the characteristic feature is stereotypic paroxysmal ambulation during sleep, often with agitation and accompanied by screaming and bizarre, dystonic movements. (2) Nocturnal Paroxysmal Dystonia (NPD) with a longer duration (20 sec-2 min) and more complex behaviors characterized by wide-ranging, often violent, and sometimes ballistic movements, with dystonic posturing of the head, trunk and limbs, such as head rotation, torsion of the trunk and choreo-athetoid movements of the arms and legs, with vocalization. classified the nocturnal FLE (NFLE) epileptic seizures into three groups, according to Montagna : (1) Paroxysmal Arousals (PA) with brief (<20 sec) episodes in which patients suddenly open their eyes, raise their heads or sit up in bed with a bizarre posture of the limbs, staring around with a frightened or surprised expression, and sometimes screaming they then return to sleep. On the basis of the different intensity, duration and features of the motor patterns, Provini et al. This scenario further increases the risk of incorrectly diagnosing a parasomnia as the basis of these abnormal nocturnal behaviors. Repetitive and stereotypical behaviors characterize the clinical presentation without change in scalp EEG the aura and the postictal periods can be masked by sleep. ![]() FLE presents with bizarre behaviors, frequent short attacks, rapid recovery, and substantial preservation of consciousness. However, epilepsy with bizarre behaviors is usually caused by frontal lobe epilepsy (FLE) or temporal lobe epilepsy (TLE). This scenario poses a major challenge for sleep clinicians. Since nightmares and sleepwalking can be components of the nocturnal symptom complex, parasomnias can be incorrectly diagnosed as the basis for these sleep related behaviors and disturbed dreams, and then subsequently incorrectly treated. Extreme restlessness, excessive swallowing movements, nightmares, and sleepwalking may represent various phenomena of seizures that emerge from sleep. Some types of sleep-related epilepsy present with bizarre behaviors or vocalization, but without convulsion-like movement, tongue biting or upward gaze. Subsequent studies of subjects with either partial or generalized seizures have estimated that the relative incidence of seizures during sleep is from 7.5% to 30%. In 1881, Gowers documented that 21% of epilepsy patients had seizures exclusively during sleep. Nocturnal frontal lobe epilepsy (sporadic, familial), Nocturnal paroxysmal dystonia, Paroxysmal arousals, Nocturnal temporal lobe epilepsy, Video-polysomnography, Anticonvulsant therapy Anticonvulsant therapy was highly effective in all eight cases (>75% reduction in seizure frequency).ĭISCUSSION: These cases confirm that sporadic NFLE closely resembles familial NFLE, and comprises a set of distinct clinical manifestations, with variable intensity, and variable scalp EEG epileptiform abnormalities across sleep and wakefulness, which have previously been identified in Caucasian patients from Europe and North America. During vPSG studies, three of eight patients with NFLE seizure events had concurrent epileptiform EEG activity, and two patients had interictal epileptiform EEG activity during their vPSG studies. Daytime awake EEGs were negative for ictal/interictal activity in all patients, but two patients had daytime sleep EEGs with interictal epileptiform EEG activity. ![]() MRI brain scan abnormalities with clinical correlates were found in one patient. NFLE subtypes: nocturnal paroxysmal dystonia, n=6 paroxysmal arousals, n=2. Premorbid history was negative for any neurologic, medical or psychiatric disorder. RESULTS: Gender was equal (four males, four females) mean age was 18.4 yrs (range, 7-41 yrs). All patients had clinical evaluations, daytime waking and sleeping EEGs, brain MRIs, and overnight video-polysomnography (vPSG) with seizure montage. METHODS: Eight consecutive cases of sporadic NFLE were evaluated at a sleep clinic in Taiwan. ![]() Both forms of NFLE need to be distinguished from para-somnias, nocturnal temporal lobe epilepsy, and other nocturnal disorders. OBJECTIVE: To present findings on a series of cases of sporadic nocturnal frontal lobe epilepsy (NFLE), a form of NFLE that is infrequently reported, in contrast to familial (autosomal dominant) NFLE. ![]()
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