Parasomnias and nocturnal frontal lobe epilepsy (NFLE): Lights and shadows – Controversial points in the differential diagnosis
Section snippets
NFLE and parasomnias: The definition
Parasomnias are defined as “clinical disorders that are not abnormalities of the processes responsible for sleep and awake states, but are undesirable physical phenomena that occur predominantly during sleep” [1]. Parasomnias usually manifest as central nervous system activation, with autonomic nervous system changes and skeletal muscle activity. These events tend to occur during childhood, more often with episodic recurrence, but onset or persistence during adulthood is not rare. The
NFLE and parasomnias: The history
The difficulties in the differential diagnosis of motor events occurring during different phases of sleep arose in the early 1970s when prolonged video EEG monitoring, formerly used in the pre-surgical study of epileptic seizures, was applied to sleep studies [8], [9], [10]. In 1977 Pedley and Guilleminault described some cases of episodic nocturnal wandering (ENW) with inconclusive electroencephalography (EEG) recordings, which they considered epileptic in nature because of the bizarre complex
Controversial issues
Even if many aspects regarding parasomnias and NFLE have now been clarified, the problem of differential diagnosis remains the clinical challenge it was in the early 80s, and several controversial issues are the matter of ongoing debate.
Conclusions
So far no single, valid, and reliable diagnostic procedure (including V-PSG) or diagnostic algorithm has been defined for parasomnias and NFLE. First, we need to improve the sensitivity of the diagnostic tools, studying the use of home-made videos before or instead of hospitalization and VPSG. Second it is important to devise common criteria to develop a single classification of motor events occurring during sleep and thereby make VPSG more reliable. In addition, a reliable motor disorders
Disclosure of financial support and conflicts of interest
Professor Lugaresi and Doctors Bisulli, Vignatelli, and Leta have reported no financial support or conflict of interest. Professor Tinuper has consulted for Cyberonics, Eisai, GSK, Janssen-Cilag, Novartis, Sanofi-Aventis, UCB. Doctor Provini has consulted for Sanofi-Aventis.
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2021, Sleep MedicineCitation Excerpt :SHE seizures may have a bizarre semeiology, with vocalization, complex automatisms, and ambulation. Conversely, some DoA episodes may be violent and can be confused with SHE [29]. This probably justifies the positivity of some SHE patients on SW or CA after being administered the ADQ (Table 3).
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2020, Brain and DevelopmentCitation Excerpt :Video-EEG and polysomnography come to aid in such situations, by allowing the observation of the sleep stage in which the events occur as well as document the exact event manifestation [2]. The main characteristics differentiating nocturnal seizures from parasomnias are: sleep stage, episode duration, vocalization characteristics, lateralized or abnormal posture, exploratory behavior [1]. The current literature stipulates that rapid eye movement (REM) sleep has a protective effect against seizures by suppression of interictal epileptic discharges [3], while non-rapid eye movement (NREM) sleep has a kindling effect [4].