Sleep‐related hypermotor epilepsy activated by rapid eye movement sleep

Abstract

Most sleep‐related seizures occur during non‐rapid eye movement (NREM) sleep, particularly during stage changes. Sleep‐related hypermotor epilepsy (SHE) is a rare epileptic syndrome characterized by paroxysmal motor seizures, mainly arising from NREM sleep. Here, we report a patient with SHE who had seven seizures captured on video‐EEG‐polysomnography during REM sleep. Ictal semiology of this patient ranged from brief paroxysmal arousals to hypermotor seizures. On EEG‐polysomnography, the spontaneous arousals were more frequent during REM than NREM sleep, with a considerably higher arousal index in REM sleep (20/hour). While the reason for seizures during REM sleep in this patient is unclear, we speculate that the threshold and mechanisms of arousal during different sleep stages may be related to the occurrence of seizures. [Published with video sequences on http://www.epilepticdisorders.com].

Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy

“…Other nocturnal events may mimic the sleep-related epilepsies and are discussed elsewhere in this issue of Neurotherapeutics (see reviews on NREM parasomnias and REM sleep behavior disorder; Table 1). Distinguishing sleep-related epilepsies and post-ictal state from parasomnias can be difficult [48] and often are frequent with recurrence several times within a single night and involve highly stereotyped complex motor behaviors that may begin either during childhood or as an adult [48]. NREM parasomnias are considered to be disorders of arousal and typically may occur during the first half of the night (and especially during the first one third of a night) since they arise most often from N3 (slow wave) sleep, and these events can be associated with triggering factors such as sleep deprivation, environmental noise, or sleep disorders that trigger arousals like apneas or hypopneas during sleep.…”