Sleeping in fits and starts: a practical guide to distinguishing nocturnal epilepsy from sleep disorders

Derry, Christopher P.

doi:10.1136/practneurol-2014-000890

Cited by 14 publications

(10 citation statements)

References 42 publications

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“…As both epilepsy and many parasomnias are paroxysmal events associated with behavioral changes, there is frequently diagnostic confusion between the two. 27 Also, like seizures, parasomnias are rarely (if ever) witnessed by the physician, and diagnosis depends on sometimes questionable history from patients and onlookers. Because parasomnias usually occur at night, onlookers frequently do not see the onset of the episode.…”

Section: Diagnostic Issuesmentioning

confidence: 99%

Sleep and Epilepsy

Bazil

2017

Semin Neurol

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The neurophysiology of the brain is complicated and nuanced. It is responsible for the normal sleep/wake states that every person experiences, and for the changes in brain neurophysiology that result in epileptic seizures and in disorders of sleep. It is therefore not surprising that sleep, sleep disorders, and epilepsy interact on many levels. The sleep state influences the detection of interictal epileptiform discharges, important for diagnosis of epilepsy. The state of sleep also influences whether a seizure will occur at a given time, and this differs considerably for various epilepsy syndromes. Sleep disruption of any kind, including from sleep disorders, can worsen epileptic seizures and contribute to intractability. Finally, anticonvulsant medications can influence sleep and sleep disorders in both positive and negative ways. Understanding this interplay between epilepsy and sleep is helpful in the optimal treatment of all patients with epileptic seizures.

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Section: Diagnostic Issuesmentioning

confidence: 99%

Sleep and Epilepsy

Bazil

2017

Semin Neurol

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“…Nocturnal frontal lobe epilepsy (NFLE) manifests at any age but most commonly in childhood (mean, 14 AE 10 years). 60 The diagnosis is sometimes difficult, and symptoms are often mistaken for parasomnia or other nonepileptic sleep disorders. In a clinical and polygraphical overview of 100 consecutive cases, Provini et al 61 The majority of the patients are not aware of their nocturnal motor behavior.…”

Section: Nocturnal Frontal Lobe Epilepsymentioning

confidence: 99%

“…61 Distinguishing NFE from nonepileptic parasomnias is sometimes difficult. The EEG may be nondiagnostic, but key features of NFLE and parasomnia are helpful for differentiation 60 : Home videos and the application of "The Frontal Lobe Epilepsy and Parasomnias (FLEP)" scale may be helpful in differentiation, and video-EEG polysomnography is recommended when differentiation is not possible by history. 60…”

Section: Nocturnal Frontal Lobe Epilepsymentioning

confidence: 99%

Sleep and Epilepsy Syndromes

Schmitt

2015

Neuropediatrics

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Sleep and epilepsy have a close relationship. About 20% of patients suffer seizures only during the night, approximately 40% only during the day and approximately 35% during the day and night. In certain epilepsy syndromes, the occurrence of seizures is strongly related to sleep or awakening. Infantile spasms appear predominately on awakening, and hypsarrhythmia is sometimes visible only in sleep. Children with Panayiotopoulos syndrome or benign epilepsy with centrotemporal spikes (BECTS) have seizures mostly when asleep, and in both syndromes interictal spike waves are markedly accentuated in slow wave sleep. Electrical status epilepticus during slow sleep/continuous spike wave discharges during sleep (ESES/CSWS), atypical benign partial epilepsy, and Landau?Kleffner syndrome are epileptic encephalopathies with substantial behavioral and cognitive deficits, various seizures, and continuous spike?wave activity during non?rapid eye movement (NREM) sleep. The hallmark of juvenile myoclonic epilepsy and grand mal seizures on awakening are seizure symptoms within 2 hours after awakening, often provoked by sleep deprivation. Nocturnal frontal lobe epilepsy is sometimes mistaken for parasomnia. Differentiation is possible when the clinical symptoms and the frequency of the paroxysmal events per night and month are carefully observed and nocturnal video electroencephalography (EEG) performed. Sleep EEG recordings may be helpful in patients with suspected epilepsy and nonconclusive awake EEG. Depending on the clinical question, sleep recordings should be performed during nap (natural sleep or drug induced), during the night, or after sleep deprivation.

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“…2,6 A high degree of interaction with the environment (conversation/complex behavior such as opening drawers) is uncommon in epilepsy. 7 Recollection of the attack is suggestive of NFLE, but no recollection may occur in both NFLE and NREM parasomnias. 7 Patients with NFLE usually fully arouse after an event and the event has a clear offset, in contrast to patients with NREM parasomnias.…”

mentioning

confidence: 99%

“…7 Recollection of the attack is suggestive of NFLE, but no recollection may occur in both NFLE and NREM parasomnias. 7 Patients with NFLE usually fully arouse after an event and the event has a clear offset, in contrast to patients with NREM parasomnias. 8 More than half of seizures in NFLE arise from NREM 2 sleep, while NREM parasomnias often arise from NREM 3 sleep.…”

mentioning

confidence: 99%

Pearls & Oy-sters: Diagnostic challenges in nocturnal frontal lobe epilepsy

Cox

Lammers

Thijs³

et al. 2016

Neurology

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PEARLS• Nocturnal frontal lobe epilepsy (NFLE) is best diagnosed by combined EEG-video recording.• Clinical features of events can contribute to differentiation of NFLE and a parasomnia. OY-STERS• In many cases, the scalp EEG is unable to detect interictal and even ictal abnormalities, because the frontal lobe focus may be too deep to be detected.CASE REPORT A 43-year-old man of normal intelligence consulted our outpatient clinic for nocturnal events that had started at age 32 years. These arise from sleep when he suddenly awakens, experiencing fear and the sensation of falling into a black hole or choking. He recalls raising his body and turning his head but does not recall what happens afterwards. His partner reported the events to be stereotyped, and occurring mostly after 1-2 hours of sleep. After rising, he falls backwards in the bed and jerks his arms and legs. He is unconscious for 3-5 minutes. Afterwards, he is confused and disorientated, and sometimes wanders through the house. These events occur once every 2 months and are debilitating. They affect his relationship and cause daytime sleepiness. Serial EEGs (including sleep deprivation), polysomnography, and MRI of the brain were normal. The individual was referred to our clinic for a 24-hour EEG video recording aiming to record an event. This EEG showed sporadic interictal epileptiform discharges (sharp waves, slow spike wave complexes), predominantly over the left frontotemporal area, but also over the right frontotemporal and frontal areas. During the night, 4 almost identical events occurred during non-REM (NREM) 1 and 2 sleep. In these events, the patient abruptly rose from the bed, looked around with an anxious expression, and went back to sleep after less than 20 seconds. In 2 events, an extension of the right hand was noted. The episodes were not followed by a phase of limb-shaking or by disorientation. He did not call the nursing staff or remember the episodes afterwards. The EEG showed a K-complex at the beginning of each of these events, followed by a diffuse 11-12 Hz rhythm for several seconds, and was once followed by a short delta rhythm over the left frontotemporal region ( figure). The episodes were accompanied by an acceleration of heart rate (from 54 to 72 bpm). After the event, when he closed his eyes again, a normal posterior dominant a rhythm was seen. As the events did not clinically resemble a physiologic arousal (due to the abrupt onset, marked stereotypy, and the tonic extension of the right hand), and in combination with the consistent (ictal) EEG findings, these episodes were considered to be of epileptic origin, and a diagnosis of NFLE was made (with paroxysmal arousals, sometimes with secondary generalization). Based on our findings during the EEG video recording, we speculated that the patient probably had more seizures than previously reported, which could also explain the excessive daytime sleepiness (EDS Three different types of NFLE seizures can occur: paroxysmal arousals, nocturnal paroxysmal dystonia, and episodic noc...

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Sleeping in fits and starts: a practical guide to distinguishing nocturnal epilepsy from sleep disorders

Cited by 14 publications

References 42 publications

Sleep and Epilepsy

Sleep and Epilepsy

Sleep and Epilepsy Syndromes

Pearls & Oy-sters: Diagnostic challenges in nocturnal frontal lobe epilepsy

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