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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All eight cases had sporadic NFLE, without any positive family history. 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. Through validation of this scale in patients with established diagnoses, we have confirmed the value of the clinical history in fflep diagnosis of nocturnal events.
The study population comprised patients who had been referred to a sleep physician or neurologist with a history of nocturnal events of uncertain cause.
For interviewer 1 nonmedically trainedsensitivity was 1.
Sleep Science – Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases
Sleep-related screaming as a manifestation of frontal lobe epilepsy in a 8 year-old girl: Paroxysmal motor disorders of sleep: Patient 8 who was maintained on anticonvulsant medication did not have an attack, but she had interictal epileptiform discharges spike and waves during the overnight vPSG study, and attacks were viewed with event video home recording provided by her family. The second group comprised cases in which there was diagnostic uncertainty on the basis of the history alone and in which the diagnosis was established by video-EEG or PSG monitoring.
In the PA episodes, the first movement usually involved the upper limbs: Intracerebral activity video-EEG was monitored concurrently with scalp EEG and documented many rolling pelvic movements related to arousal fluctuations during NREM sleep and lasting sec.
It was then validated in a sample of individuals with firmly diagnosed nocturnal events. Routine daytime awake and sleep EEG recordings were also performed for these patients.
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 the diagnosis.
Epilepsy and sleep.
scalr NREM sleep arousal parasomnia, such as sleepwalking, sleep terrors, confusional arousals. Semistructured interviews were conducted twice for each subject by different researchers on separate occasions; the 2 interviews were at least 4 weeks apart.
A clinical and polygraphic overview of consecutive cases. Questions were designed to address those features that, according to the medical literature and in the experience of the health care professionals involved, are useful in discriminating between the conditions Figure 1. On the basis of the different intensity, duration and features of the motor patterns, Provini et al.
Neurology ;42 7 Suppl.
Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases
PAs featured head elevation always with open eyes followed by truncal elevation, with the patient sitting up and looking around for a few seconds. A manual of standardized terminology, techniques, and scoring systems for sleep stages of human subjects.
Waking EEG was normal in all patients, and epileptiform abnormalities were documented during sleep in two patients. Sleep disordered breathing in patients with epilepsy Bhuma VengammaJ. Citations Publications citing this paper. The prevalence of parasomnias in preadolescent school-aged children: Long-term home monitoring of hypermotor seizures by patient-worn accelerometers. Differentiating parasomnias from nocturnal seizures. Likewise, prompt investigation and treatment will be possible in those individuals with epilepsy.
Particular consideration was given to the nonrapid eye movement NREM arousal parasomnias, such as sleep walking and night terrors, because these conditions are most commonly confused with NFLE, 810 but the scale was designed to be broadly applicable. Some types of sleep-related epilepsy present with bizarre behaviors or vocalization, but without convulsion-like movement, tongue biting or upward gaze.
Due to safety considerations , oxcarbamazepine was also the initial treatment of choice. A choice of possible responses was assigned to each question, each with a score.
Table 2 from Epilepsy and sleep. – Semantic Scholar
Berkovic Archives of neurology Comparison with other studies. Major attacks began with the same movements observed with MMEs followed by hypertonic posturing of the right arm and pelvic thrusting.
During MMEs, the stereo-EEG showed a burst of rhythmic sharp activity within the supplementary sensorimotor area, the frontal and central cignulate gyrus and the posterior part of the middle frontal gyrus.
When the episode stopped spontaneously, the patient told the attending sleep technologist that she had just been dreaming that her older sister was shoving a ruler in and out of her vagina just as the sister had done during her childhood, besides pinning her shoulders to the bedwhich was causing her a lot of pain.
Copyright American Medical Association. Clinical features that may be useful in distinguishing nocturnal frontal lobe epilepsy NFLE from parasomnias.
Create a free personal account to access your subscriptions, sign up for alerts, and more. Parasomnias need to be carefully considered in the differential diagnosis of NFLE . SczleSaurabh R. Paroxysmal events in sleep may pose a significant diagnostic challenge to the clinician.