Awake seizures after pure sleep-related epilepsy: a systematic review and implications for driving law

Thomas, Rhys H.; King, W. H.; Johnston, Janet; Smith, Pem

doi:10.1136/jnnp.2009.181438

Cited by 24 publications

(17 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies indicate that about 12% of epileptic patients, 24 , 25 mostly with a diagnosis of focal epilepsy, 26 , 27 suffered from sleep-related seizures, defined as “seizures occurring exclusively or predominantly (>90 %) during sleep”. SHE represented the diagnosis in 13% of patients referred to a tertiary center for a video-polysomnographic evaluation of nocturnal motor disorders 11 and in 9.4% of our population of focal drug-resistant epileptic patients (unpublished data).…”

Section: Clinical and Diagnostic Criteria For Shementioning

confidence: 99%

Sleep-related hypermotor epilepsy: prevalence, impact and management strategies

Menghi

Bisulli

Tinuper

et al. 2018

NSS

View full text Add to dashboard Cite

Sleep-related hypermotor epilepsy (SHE), previously called nocturnal frontal lobe epilepsy (NFLE), is a focal epilepsy characterized by asymmetric tonic/dystonic posturing and/or complex hyperkinetic seizures occurring mostly during sleep. SHE fulfills the definition of rare disease with an estimated minimum prevalence of 1.8/100,000 individuals, and it represents about 10% of drug-resistant surgical cases. Although SHE and autosomal-dominant SHE (ADSHE) have been considered benign epileptic conditions for a long time, emerging data have shed light on the severity of this disorder and some peculiar features can impact negatively on the quality of life of SHE patients. In fact, seizure frequency can be very high, resulting in nocturnal sleep fragmentation with possible diurnal consequences such as excessive sleepiness and fatigue. Moreover, recent studies, adopting a systematic neuropsychological assessment, have shown deficits in memory, executive functions and visuo-spatial abilities in almost half of SHE patients. Intellectual disabilities and psychiatric disorders have also been reported in some genetic forms. SHE may also exert a negative effect on health-related quality of life, especially in domains pertaining to a patient’s role in the family, social context and patient’s illness experience.Despite a good response to pharmacological treatment, especially with carbamazepine, 30% of SHE patients suffer from drug-resistant seizures. Finally, recent studies suggest a poor prognosis in a high percentage of SHE patients with a 20.4% cumulative probability of achieving terminal remission at 10 years from onset. For selected drug-resistant SHE patients, epilepsy surgery is the only treatment offering high probability of recovery, both for seizures and for epilepsy-related sleep alterations.

show abstract

Section: Clinical and Diagnostic Criteria For Shementioning

confidence: 99%

Sleep-related hypermotor epilepsy: prevalence, impact and management strategies

Menghi

Bisulli

Tinuper

et al. 2018

NSS

View full text Add to dashboard Cite

show abstract

“…The frequency of pure sleep-related seizures, defined as "seizures occurring exclusively or predominantly (>90 %) from sleep" clusters around 12 % of people with epilepsy [17,18], the majority of patients being affected by focal epilepsy [19,20]. NFLE is probably not rare, accounting for 13 % of polysomnographic recordings for nocturnal motor disorders in a retrospective study performed at a tertiary centre in Italy [12] and for 6.3 % of a large series of focal drug-resistant epileptic patients (unpublished data).…”

Section: Epidemiology Of Nflementioning

confidence: 99%

Nocturnal Frontal Lobe Epilepsy

Nobili

Proserpio

Combi

et al. 2014

Curr Neurol Neurosci Rep

View full text Add to dashboard Cite

Nocturnal frontal lobe epilepsy (NFLE) is a syndrome of heterogeneous etiology, characterized by the occurrence of sleep-related seizures with different complexity and duration. Genetic, lesional, and cryptogenetic NFLE forms have been described. NFLE is generally considered a benign clinical entity, although severe, drug-resistant forms do exist. A significant proportion of sleep-related complex motor seizures, hardly distinguishable from NFLE, originate outside the frontal lobe. Moreover, the distinction of NFLE from the non-rapid eye movement arousal parasomnias may be challenging. A correct diagnosis of NFLE should be based on a diagnostic approach that includes the anamnestic, video-polysomnographic, morphological, and genetic aspects. Studies on the relationships between genes, arousal regulatory mechanisms, and epileptogenesis, using both clinical and experimental models of NFLE might provide key insights in the interrelationship between sleep and epilepsy.

show abstract

“…8 Special exceptions for patients with seizures occurring only from sleep or with consistent and reliable auras reflect a first, pragmatic step in this direction, 47 but -at least in the case of purely sleep-related epilepsy -the evidence base for current exceptions remains uncomfortably thin. 48 Licensing conditions other than a ban from driving can be imposed in some countries, for example Australia, and include restricting the number of passengers or prohibiting motorway driving. 49…”

Section: Risk Analysismentioning

confidence: 99%