The Sleep Manifestations of Frontal Lobe Epilepsy

Abstract

Frontal lobe seizures have a tendency to occur from sleep, and in some cases occur exclusively (or almost exclusively) from sleep; these individuals are said to have nocturnal frontal lobe epilepsy (NFLE). NFLE can be difficult to distinguish clinically from various other sleep disorders, particularly parasomnias, which also present with paroxysmal motor activity in sleep. Here, the manifestations of frontal lobe epilepsy are reviewed in detail, with particular reference to the influence of sleep and the characteristics of NFLE. Key aspects of differential diagnosis are also considered, and the underlying mechanisms involved in NFLE discussed.

Quantitative analysis of phenotypic elements augments traditional electroclinical classification of common familial epilepsies

“…Variables that can be seen in both temporal and extratemporal seizures, such as autonomic symptoms and focal‐BTC seizures, were not distinguished by these class assignments. Seizures during sleep were associated with class 4, consistent with evidence that seizures during sleep are more common in frontal lobe epilepsy than in temporal lobe epilepsy . The model grouped together frontal lobe epilepsy with SLFEs of childhood; these epilepsy subtypes have many features in common (nocturnal seizures, motor symptoms) and although they present as distinct clinical entities, their similarities may hint at shared underlying mechanisms.…”

Sleep disturbance in childhood epilepsy: clinical implications, assessment and treatment

“…For example, in NFLE, psychogenic attacks may well be suspected because the seizures can include complex non-convulsive movements and sometimes dramatic vocalisations, and EEG recordings can be normal even during the attacks. Guidelines have been suggested for differentiating non-epileptic parasomnias from nocturnal seizures22 and, more specifically, distinguishing between NFLE and arousal disorders 23. The clinical features of non-convulsive status epilepticus are open to various misinterpretations including some form of sleep disorders 24…”

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

“…And second, they have a strong preponderance to occur from sleep. Most people with frontal lobe epilepsy have a large proportion of their seizures during sleep,4 with those who have 90% or more from sleep said to have ‘NFLE’ 3. This can be difficult to diagnose correctly, and may often be mistaken for a non-epileptic sleep disorder.…”

“…This contrasts with many other seizure types—for example, tonic-clonic seizures and temporal lobe seizures in different patients generally look very similar to the observer. A full review of the semiology of frontal lobe seizures is beyond the scope of this article, and can be found elsewhere,4 but the events are often bizarre and dramatic. The most commonly reported features include:

aura (often non-specific, sometimes a choking sensation7).

…”