SUMMARY. Purpose: To test the usefulness of the FLEP scale in diagnosing nocturnal frontal lobe epilepsy (NFLE), arousal parasomnias, and. The Frontal Lobe Epilepsy and Parasomnias (FLEP) Scale. Clinical Feature. Score. Age at onset. At what age did the patient have their first clinical event? < 55y. Created by Derry and colleagues , the item FLEP scale is designed to aid clinicians in distinguishing frontal lobe seizures from parasomnias.
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Twenty-eight NPD episodes were recorded from six patients, lasting from 22 to 55 sec mean Routine flpe awake and sleep EEG recordings were also performed for these patients. Patient 6 was referred from a pediatric neurologist and was still under control with sodium valproate therapy, mg bid and levetiracetam, f,ep bid. J Clin Sleep Med glep Sinha Journal of clinical neurophysiology: The first patient, a year-old male, had very frequent major motor attacks during NREM sleep, along with numerous MMEs lasting sec that consisted of left head and eye deviation.
Prolonged episodes of PAs were followed by brief dystonic movements of the limbs and pelvic thrusting or fully developed bilateral hypertonic-hyperkinetic activity. Paroxysmal events in sleep may pose a significant diagnostic challenge to the clinician.
Waking EEG was normal in all patients, and epileptiform abnormalities were documented during sleep in two patients. The distribution of scores according to diagnosis is given in Figure 2.
Therefore, the presence of sleep-related hyperkinetic seizures is not specific to NFLE, as they can also be found with nocturnal temporal lobe epilepsy. Repetitive and stereotypical behaviors characterize the clinical presentation without change in scalp EEG; the aura and the postictal periods can be masked by sleep.
Sleep Science – Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases
Purchase access Subscribe now. Neurology ;42 7 Suppl. Davey, Johns, Scheffer, and Berkovic. Comparison with other studies. We therefore only had video-EEG or PSG data on those patients with atypical parasomnias, in whom the diagnosis was regarded as uncertain. Johns, Kron, Glencross, and Berkovic.
Sleep and Hypnosis ;3: Reactivation of seizure-related changes to interictal spike shape and synchrony during postseizure sleep in patients. None of the patients had any adverse effects or complaints related to treatment. EEG flp channels 12—19 shows with a run of sharp waves during the event episode. Patient 8 who was maintained on anticonvulsant medication did not have an attack, but she had scaoe epileptiform discharges spike and waves during the overnight vPSG study, and scqle were viewed with event video home recording provided by her family.
Showing of 16 extracted citations. New approach for analyzing self-reporting of insomnia symptoms reveals a high rate of comorbid insomnia across a wide spectrum of chronic diseases. Autosomal dominant nocturnal frontal lobe epilepsy: Nocturnal frontal lobe epilepsy vs parasomnias.
Recent studies have provided new insights into the links between fle; disorders that may facilitate differential diagnosis and treatment but may also improve our understanding of underlying pathophysiological mechanisms.
Parasomnias and other nocturnal events. In the PA episodes, the first movement usually involved the upper limbs: WalkerJohn S.
Diagnostic and Coding Manual. The nicotinic receptor beta 2 subunit is mutant in nocturnal frontal lobe epilepsy.
Nocturnal epilepsy in adults.
For example, clues for distinguishing nocturnal seizures from sleep terrors include the following : Skip to search form Skip to main content.
Of the 62 patients interviewed, 3 had their conditions incorrectly diagnosed using the scale; these were all patients with parasomnias who generated low positive scores. Nocturnal epileptic seizures versus the arousal parasomnias. Diagnosing Bumps in the Night.
The same central pattern generators for the same behaviours. All episodes occurred during NREM sleep. A high degree of suspicion combined with knowledge of the characteristics that distinguish nocturnal epileptic seizures from other nocturnal paroxysmal events is necessary to make fldp diagnosis.
The reported findings of Derry et al. Long-term home monitoring of hypermotor seizures by patient-worn accelerometers. This activity persisted approximately 40 sec and culminated with clonic movements of the right hand. References Publications referenced by this paper. Sleeptalking occurred with arousal after the pelvic movements.
Strengths and weaknesses of the study. The second patient, a year-old woman with a positive family history of parasomnia, had almost exclusively nocturnal high-frequency seizures with rolling movements of the pelvis followed by hypertonic-hyperkinetic activity and sleeptalking with bruxism. Prevalence and comorbidity of nocturnal wandering in the U.
They are expensive and inconvenient investigations requiring admission to the hospital and are only practical if the nocturnal events are happening on a frequent, preferably nightly, basis. From a practical perspective, there was a small degree of overlap in the FLEP scores for the 2 groups.