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Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases.

Yeh SB, Schenck CH - Sleep Sci (2014)

Bottom Line: No case had a spontaneous remission.Anticonvulsant therapy was highly effective in all eight cases (>75% reduction in seizure frequency).These cases confirm that sporadic NFLE closely resembles familial NFLE, and comprises a set of distinct clinical manifestations, with variable intensity, and variable scalp EEG epileptiform abnormalities across sleep and wakefulness, which have previously been identified in Caucasian patients from Europe and North America.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology (and Sleep Center), Changhua Christian Hospital Yun Lin Branch and Department of Neurology (and Sleep Center), St Martin de Porres Hospital; Chiayi City, Taiwan (ROC).

ABSTRACT

Objective: To present findings on a series of cases of sporadic nocturnal frontal lobe epilepsy (NFLE), a form of NFLE that is infrequently reported, in contrast to familial (autosomal dominant) NFLE. Both forms of NFLE need to be distinguished from parasomnias, nocturnal temporal lobe epilepsy, and other nocturnal disorders.

Methods: Eight consecutive cases of sporadic NFLE were evaluated at a sleep clinic in Taiwan. All patients had clinical evaluations, daytime waking and sleeping EEGs, brain MRIs, and overnight video-polysomnography (vPSG) with seizure montage.

Results: Gender was equal (four males, four females); mean age was 18.4 yrs (range, 7-41 yrs). Age of NFLE onset was by puberty. Premorbid history was negative for any neurologic, medical or psychiatric disorder. NFLE subtypes: nocturnal paroxysmal dystonia, n=6; paroxysmal arousals, n=2. MRI brain scan abnormalities with clinical correlates were found in one patient. Daytime awake EEGs were negative for ictal/interictal activity in all patients, but two patients had daytime sleep EEGs with interictal epileptiform EEG activity. During vPSG studies, three of eight patients with NFLE seizure events had concurrent epileptiform EEG activity, and two patients had interictal epileptiform EEG activity during their vPSG studies. No case had a spontaneous remission. Anticonvulsant therapy was highly effective in all eight cases (>75% reduction in seizure frequency).

Discussion: These cases confirm that sporadic NFLE closely resembles familial NFLE, and comprises a set of distinct clinical manifestations, with variable intensity, and variable scalp EEG epileptiform abnormalities across sleep and wakefulness, which have previously been identified in Caucasian patients from Europe and North America.

No MeSH data available.


Related in: MedlinePlus

Nocturnal PSG (10s epoch) during N2 sleep and the emergence of epileptiform EEG discharge. EEG montage (channels 12–19) shows a run of spike-and-waves during an interictal period. The electrooculogram (channels 7–8) indicates no rapid eye movements. The electrocardiogram (channel 11) is unremarkable during the interictal epileptiform EEG discharge. Channels 20–23 represent the nasal/oral airflow, chest respiratory effort, abdomen respiratory effort and O2 saturation, which do not show any sleep apnea, oxygen desaturation, or tachypnea.
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f0010: Nocturnal PSG (10s epoch) during N2 sleep and the emergence of epileptiform EEG discharge. EEG montage (channels 12–19) shows a run of spike-and-waves during an interictal period. The electrooculogram (channels 7–8) indicates no rapid eye movements. The electrocardiogram (channel 11) is unremarkable during the interictal epileptiform EEG discharge. Channels 20–23 represent the nasal/oral airflow, chest respiratory effort, abdomen respiratory effort and O2 saturation, which do not show any sleep apnea, oxygen desaturation, or tachypnea.

Mentions: All eight cases had normal wake scalp EEG activity. In six patients (75%), sleep EEG was completely normal. Only two patients (25%) showed focal frontal epileptic abnormalities. EEG recordings during the attacks failed to disclose ictal epileptic activity in four cases. In such cases, EEG was often masked by muscle artifacts or characterized by an abrupt transition to wake activity or light sleep, occasionally (patient 6) preceded by a K-complex. EEG recordings during the attacks did record ictal activity in three cases: a burst of sharp waves in patient 1 (Fig. 1); background EEG activity suppression followed by a burst of sharp waves in patient 4; and continuous rhythmic sharp activity (2–6 Hz) for 50 sec, followed by slow-wave activity (1–2 Hz) in patient 5. The first EEG modifications were either a diffuse flattening of background activity (1 case), or sharp activity (four cases). In one patient (patient 8), the interictal EEG was characterized by spike-and-waves activity (Fig. 2). Autonomic hyperactivity was remarkable in many cases: tachycardia (four cases) and sustained tachypnea with tachycardia (one case) appeared synchronously with seizure onset or accompanied the movement artifacts. The supplementary video files contain examples of the behavioral correlates of seizure events recorded during the vPSG studies for patients #1, 3–7; patient #2 had suboptimal video quality, and patient #8 did not have any seizure during the vPSG study, as described. Screaming was also present in patients #4,7, vocalizations were also present in patients #1, 3, 5, and prominent tachypnea was also present in patient #1.


Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases.

Yeh SB, Schenck CH - Sleep Sci (2014)

Nocturnal PSG (10s epoch) during N2 sleep and the emergence of epileptiform EEG discharge. EEG montage (channels 12–19) shows a run of spike-and-waves during an interictal period. The electrooculogram (channels 7–8) indicates no rapid eye movements. The electrocardiogram (channel 11) is unremarkable during the interictal epileptiform EEG discharge. Channels 20–23 represent the nasal/oral airflow, chest respiratory effort, abdomen respiratory effort and O2 saturation, which do not show any sleep apnea, oxygen desaturation, or tachypnea.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4559607&req=5

f0010: Nocturnal PSG (10s epoch) during N2 sleep and the emergence of epileptiform EEG discharge. EEG montage (channels 12–19) shows a run of spike-and-waves during an interictal period. The electrooculogram (channels 7–8) indicates no rapid eye movements. The electrocardiogram (channel 11) is unremarkable during the interictal epileptiform EEG discharge. Channels 20–23 represent the nasal/oral airflow, chest respiratory effort, abdomen respiratory effort and O2 saturation, which do not show any sleep apnea, oxygen desaturation, or tachypnea.
Mentions: All eight cases had normal wake scalp EEG activity. In six patients (75%), sleep EEG was completely normal. Only two patients (25%) showed focal frontal epileptic abnormalities. EEG recordings during the attacks failed to disclose ictal epileptic activity in four cases. In such cases, EEG was often masked by muscle artifacts or characterized by an abrupt transition to wake activity or light sleep, occasionally (patient 6) preceded by a K-complex. EEG recordings during the attacks did record ictal activity in three cases: a burst of sharp waves in patient 1 (Fig. 1); background EEG activity suppression followed by a burst of sharp waves in patient 4; and continuous rhythmic sharp activity (2–6 Hz) for 50 sec, followed by slow-wave activity (1–2 Hz) in patient 5. The first EEG modifications were either a diffuse flattening of background activity (1 case), or sharp activity (four cases). In one patient (patient 8), the interictal EEG was characterized by spike-and-waves activity (Fig. 2). Autonomic hyperactivity was remarkable in many cases: tachycardia (four cases) and sustained tachypnea with tachycardia (one case) appeared synchronously with seizure onset or accompanied the movement artifacts. The supplementary video files contain examples of the behavioral correlates of seizure events recorded during the vPSG studies for patients #1, 3–7; patient #2 had suboptimal video quality, and patient #8 did not have any seizure during the vPSG study, as described. Screaming was also present in patients #4,7, vocalizations were also present in patients #1, 3, 5, and prominent tachypnea was also present in patient #1.

Bottom Line: No case had a spontaneous remission.Anticonvulsant therapy was highly effective in all eight cases (>75% reduction in seizure frequency).These cases confirm that sporadic NFLE closely resembles familial NFLE, and comprises a set of distinct clinical manifestations, with variable intensity, and variable scalp EEG epileptiform abnormalities across sleep and wakefulness, which have previously been identified in Caucasian patients from Europe and North America.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology (and Sleep Center), Changhua Christian Hospital Yun Lin Branch and Department of Neurology (and Sleep Center), St Martin de Porres Hospital; Chiayi City, Taiwan (ROC).

ABSTRACT

Objective: To present findings on a series of cases of sporadic nocturnal frontal lobe epilepsy (NFLE), a form of NFLE that is infrequently reported, in contrast to familial (autosomal dominant) NFLE. Both forms of NFLE need to be distinguished from parasomnias, nocturnal temporal lobe epilepsy, and other nocturnal disorders.

Methods: Eight consecutive cases of sporadic NFLE were evaluated at a sleep clinic in Taiwan. All patients had clinical evaluations, daytime waking and sleeping EEGs, brain MRIs, and overnight video-polysomnography (vPSG) with seizure montage.

Results: Gender was equal (four males, four females); mean age was 18.4 yrs (range, 7-41 yrs). Age of NFLE onset was by puberty. Premorbid history was negative for any neurologic, medical or psychiatric disorder. NFLE subtypes: nocturnal paroxysmal dystonia, n=6; paroxysmal arousals, n=2. MRI brain scan abnormalities with clinical correlates were found in one patient. Daytime awake EEGs were negative for ictal/interictal activity in all patients, but two patients had daytime sleep EEGs with interictal epileptiform EEG activity. During vPSG studies, three of eight patients with NFLE seizure events had concurrent epileptiform EEG activity, and two patients had interictal epileptiform EEG activity during their vPSG studies. No case had a spontaneous remission. Anticonvulsant therapy was highly effective in all eight cases (>75% reduction in seizure frequency).

Discussion: These cases confirm that sporadic NFLE closely resembles familial NFLE, and comprises a set of distinct clinical manifestations, with variable intensity, and variable scalp EEG epileptiform abnormalities across sleep and wakefulness, which have previously been identified in Caucasian patients from Europe and North America.

No MeSH data available.


Related in: MedlinePlus