Nocturnal Frontal Lobe Epilepsy

Nobili, Lino; Proserpio, Paola; Combi, Romina; Provini, Federica; Plazzi, Giuseppe; Bisulli, Francesca; Tassi, Laura; Tinuper, Paolo

doi:10.1007/s11910-013-0424-6

Cited by 68 publications

(49 citation statements)

References 104 publications

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“…First, although HMS typically have a frontal lobe onset, a non-negligible proportion of cases have a SOZ outside the frontal lobe, most commonly from temporal or operculo-insular regions. 1,3 Recent case-series of parietal-onset HMS have also been published, although none were sleep related. 4,5 Nevertheless, it seems the spread of ictal activity in these cases follows the same epileptogenic network to engage or at least perturb the frontal lobe structures responsible for the hyperkinetic behavior.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,4 Moreover, in drugresistant cases, the presence of a small type II FCD on brain MRI should strongly be suspected since this histopathological substrate has often been associated with sleep related seizures, independent of its cortical location. 1,3 When the limits of such a lesion is unclear, as in our case, or overlaps eloquent cortex, invasive intracranial EEG monitoring is warranted, not to confirm the diagnosis of epilepsy but to identify the SOZ and possibly offer a curative surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The hallmark seizure consists of asymmetric tonic/dystonic postures or complex hypermotor movements, lasting about 30 seconds and occurring many times per night. 1 Stereo-electroencephalographic (stereo-EEG) studies conducted in drug-resistant patients have identifi ed the ventromesial frontal cortex and anterior cingulate gyrus regions of the frontal lobe as the structures mainly involved during a hypermotor seizure (HMS). 2 Here we report an unusual case of a patient presenting classic NFLE features arising from the mesial parietal region.…”

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confidence: 99%

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Sleep Related Hypermotor Seizures with a Right Parietal Onset

Gibbs

Figorilli

Casaceli

et al. 2015

Journal of Clinical Sleep Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Sleep Related Hypermotor Seizures with a Right Parietal Onset

Gibbs

Figorilli

Casaceli

et al. 2015

Journal of Clinical Sleep Medicine

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“…[1][2][3][4][5] Reviews have been published on the mutual influence and the interrelationship between epilepsy and sleep. [6][7][8][9][10][11][12][13] The diagnostic challenges of sleep-related epileptic and nonepileptic behaviors like non-rapid eye movement (NREM) parasomnias have also been described. [3,4,[14][15][16][17][18] Because of the authors' expertise in sleep medicine, electrophysiology and epilepsy surgery, this article will adopt a different approach and highlight the clinical and pathophysiological insights into sleep-related epileptic and nonepileptic paroxysmal behaviors that were gained from the use of stereoelectroencephalography (S-EEG) recordings during the presurgical evaluation of drug-resistant focal epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Sleep-related epileptic behaviors and non-REM-related parasomnias: Insights from stereo-EEG

Gibbs

Proserpio

Terzaghi

et al. 2016

Sleep Medicine Reviews

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102

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During the last decade, many clinical and pathophysiological aspects of sleep-related epileptic and non-epileptic paroxysmal behaviors have been clarified. Advances have been achieved in part through the use of intracerebral recording methods such as stereo-electroencephalography (S-EEG), which has allowed a unique "in vivo" neurophysiological insight into focal epilepsy. Using S-EEG, the local features of physiological and pathological EEG activity in different cortical and subcortical structures have been better defined during the entire sleep-wake spectrum. For example, S-EEG has contributed to clarify the semiology of sleep-related seizures as well as highlight the specific epileptogenic networks involved during ictal activity. Moreover, intracerebral EEG recordings derived from patients with epilepsy have been valuable to study sleep physiology and specific sleep disorders. The occasional co-occurrence of NREM-related parasomnias in epileptic patients undergoing S-EEG investigation has permitted the recordings of such events, highlighting the presence of local electrophysiological dissociated states and clarifying the underlying pathophysiological substrate of such NREM sleep disorders. Based on these recent advances, the authors review and summarize the current and relevant S-EEG literature on sleep-related hypermotor epilepsies and NREM-related parasomnias. Finally, novel data and future research hypothesis will be discussed.

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“…The etiology can be genetic (e.g., autosomal dominant NFLE), lesional, or cryptogenic. 1 There is a male predominance and age at onset varies but is usually around adolescence. 2 Most seizures occur during NREM 2 sleep.…”

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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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Nocturnal Frontal Lobe Epilepsy

Cited by 68 publications

References 104 publications

Sleep Related Hypermotor Seizures with a Right Parietal Onset

Sleep Related Hypermotor Seizures with a Right Parietal Onset

Sleep-related epileptic behaviors and non-REM-related parasomnias: Insights from stereo-EEG

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

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