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Nocturnal frontal lobe epilepsy is often misdiagnosed as sleep disorders in children: a case series

S. Miano, R. Peraita-Adrados [REV NEUROL 2013;56:257-267] PMID: 23440753 DOI: https://doi.org/10.33588/rn.5605.2013018

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Volumen 56 | Number 05 | Nº of views of the article 11.402 | Nº of PDF downloads 2.225 | Article publication date 01/03/2013

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ABSTRACT

INTRODUCTION We present a series of children who underwent a video-polysomnographic recording at our Sleep and Epilepsy Unit, who received a diagnosis of nocturnal frontal lobe epilepsy (NFLE). AIMS. To describe electroclinical and video polygraphic features of paediatric NFLE that differentiate this condition from other sleep disorders that overlap and mimic the sleep motor and autonomic events of NFLE.

PATIENTS AND METHODS The inclusion criterion was that the patients have their first video-EEG-PSG recording in our laboratory.

RESULTS Twenty-four out of 190 children were diagnosed with NFLE (group 1); while 166 had other sleep disorders (group 2). Among children diagnosed with NFLE, seven were referred for sleep-disordered breathing, seven for parasomnias, two for insomnia, two for hypersomnia, and one for periodic limb movements, while five were referred for epilepsy. In group 1, perinatal history was normal in most cases (21 out of 24) and a familiar history of epilepsy was found in four cases. Sleep-disordered breathing was diagnosed as a comorbid condition in four children. Standard EEG was normal in 21 cases. Interictal EEG showed epileptic discharges in four cases, while ictal EEG was expressed by a rhythmic theta activity preceded by an arousal and/or a short background desynchronization, movement artifacts, and autonomic changes. All seizures, repeated highly stereotyped motor events, were followed by stage shifts and/or a postural change and by short awakenings.

CONCLUSIONS We found a high percentage of children with NFLE, often misdiagnosed or associated with other sleep disorders, which may be a trigger for nocturnal seizures. KeywordsChildren Nocturnal frontal lobe epilepsy Parasomnia Pediatric sleep disorders Seizures Video-polysomnographic recording CategoriesEpilepsias y síndromes epilépticos Neuropediatría Neuropsiquiatría Sueño

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Original

Nocturnal frontal lobe epilepsy is often misdiagnosed as sleep disorders in children: a case series