Epilepsy and paroxysmal conditions

Advanced search


Full Text:


Abstract: major issues of differentiating epileptic and non-epileptic paroxysmal phenomena of sleep are presented in this article. Quality differentiation is possible in case of good knowledge of semiology of sleep-related epileptic seizure types and epileptic syndromes. Difficulties in identification can lead to further diagnostic mistakes. Parasomnias are the most frequently encountered non-epileptic paroxysmal events in sleep, which are related to both non-rapid-eye movement (NREM) sleep and rapid-eye movement (REM) sleep. NREM-sleep parasomnias are otherwise referred to as arousal disorders. They could be mistaken for frontal lobe epilepsy seizures, which predominantly occur at night and are not readily accompanied by epileptiformabnormalities on EEG. Other sleep phenomena also should be considered in differentiating nocturnal epilepsies. Obstructive sleep apnea, periodic leg movements in sleep and some sleep episodes sometimes are expressed with a pattern hardly distinguishable from epileptic seizures. Complex approach and appropriate diagnostic algorithm would further help clinicians in this field to better assess any given situation.

About the Authors

S. G. Khachatryan
Yerevan State Medical University after Mkhitar Heratsi

Yu. S. Tunyan
National Institute of Health named after academician S.Kh. Avdalbekyan, Yerevan


1. Авакян Г.Н., Анисимова А.В., Айвазян С.О. Видео-ЭЭГ-мониторинг в современной диагностике и контроле лечения эпилепсии. Пособие для врачей. М. 2006.

2. Гусев Е.И, Гехт А.Б. Современная эпилептология. М. 2011.

3. Карлов В.А. Эпилепсия у детей и взрослых, женщин и мужчин. Медицина. 2010

4. Левин Я.И. Парасомнии – современное состояние проблемы. Эпилепсия и пароксизмальные состояния. 2010; 2 (2): 10-16.

5. Bazil C.W. Nocturnal seizures. Semin. Neurol. 2004; 24: 293-300.

6. Berkovic S.F., Scheffer I.S. Autosomal dominant nocturnal frontal lobe epilepsy. In: C.W. Bazil, B.A. Malow, M.R. Samaritno, editors. Sleep and epilepsy: the clinical spectrum. Amsterdam. 2002; 217-22.

7. Bernasconi A., Andermann F., Cendes F. et al. Nocturnal temporal lobe epilepsy. Neurology. 1998; 50 (6): 1772-7.

8. Chauvel P., Kliemann F., Vignal J.P. et al. The clinical signs and symptoms of frontal lobe seizures: phenomenology and classification. Adv. Neurol. 1995; 66: 115-26.

9. Chisholm T., Morehouse R.L. Adult headbanging: sleep studies and treatment. Sleep 1996; 19: 343-6.

10. Chokroverty S., Quinto C. Sleep and epilepsy. In: S. Chokroverty, editor. Sleep disorders medicine. Boston. 1999; 697-727.

11. Craske M.G., Tsao J.C. Assessment and treatment of nocturnal panic attacks. Sleep Med. Rev. 2005; 9 (3): 173-84.

12. Derry C.P., Duncan J.S., Berkovic S.F. Paroxysmal motor disorders of sleep: The clinical spectrum and differentiation from epilepsy. Epilepsia. 2006; 47: 1775-1791.

13. Derry C., Harvey A., Walker M. et al. NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG analysis. Sleep 2009; 32 (12): 1637-44.

14. Duncan R., Oto M., Russell A.J. et al. Pseudosleep events in patients with psychogenic non-epileptic seizures: prevalence and associations. J. Neurol Neurosurg Psychiatry. 2004; 75 (7): 1009-12.

15. Dyken M.E., Rodnitzky R.L. Diagnosing rhythmic movement disorder with video-polysomnography. Pediatr. Neurol. 1992; 16: 37-41.

16. Frauscher B., Gschliesser V., Brandauer E. et al. Video analysis of motor events in REM sleep behavior disorder. Mov. Disord. 2007; 22 (10): 1464-70.

17. Grillner S., Wallen P. Central pattern generators for locomotion, with special reference to vertebrates. Annu Rev. Neurosci 1985; 8: 233-61.

18. Hooper S.L. Central pattern generators. Curr. Biol. 2000; 10 (5): R176.

19. Klackenberg G. A prospective longitudinal study of children. Data on psychic health and development up to 8 years of age. Acta Paediatr. Scand. Suppl 1971; 224: 1-239.

20. Kushida C.A., Littner M.R., Morgenthaler T. et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28 (4): 499-521.

21. Manni R., Terzaghi M. Comorbidity between epilepsy and sleep disorders. Epilepsy Res. 2010; 90: 171-177.

22. Olsen E.J., Boeve B.F., Silber M.H. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 2002; 123: 331-9.

23. Plazzi G., Tinuper P., Montagna P. et al. Epileptic nocturnal wanderings. Sleep 1995; 18 (9): 749-56.

24. Provini F., Plazzi G., Tinuper P. et al. Nocturnal frontal lobe epilepsy. A clinical and polygraphic overview of 100 consecutive cases. Brain. 1999; 122 (6): 1017-31.

25. Scheffer I.E., Bhatia K.P., Lopes-Cendes I. et al. Autosomal dominant nocturnal frontal lobe epilepsy. A distinctive clinical disorder. Brain. 1995; 118 (1): 61-73.

26. Schenck C.H., Mahowald M.W. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep. 2002; 25 (2): 120-38.

27. Spencer S.S., Spencer D.D., Williamson P.D. et al. Sexual automatisms in complex partial seizures. Neurology. 1983; 33 (5): 527-33.

28. Tassinari C.A., Rubboli G., Gardella E. et al. Central pattern generators for a common semiology in fronto-limbic seizures and in parasomnias. A neuroethologic approach. Neurol. Sci. 2005; 26 (3): 225-32.

29. Vetrugno R., Plazzi G., Provini F. et al. Excessive fragmentary hypnic myoclonus: clinical and neurophysiological findings. Sleep. Med. 2002; 3 (1): 73-6.

30. Yogarajah M., Powell H.W., Heaney D., Smith S.J., Duncan J.S., Sisodiya S.M. Long term monitoring in refractory epilepsy: The Gowers Unit experience. J. Neurol. Neurosurg. Psychiatry. 2009; 80: 305-310.

31. Zucconi M., Ferini-Strambi L. NREM parasomnias: arousal disorders and differentiation from nocturnal frontal lobe epilepsy. Clin. Neurophysiol. 2000; 111 (2): 129-35.

For citation:

Khachatryan S.G., Tunyan Yu.S. DIFFERENTIAL DIAGNOSIS OF NOCTURNAL EPILEPTIC AND NONEPILEPTIC PAROXYSMAL PHENOMENA OF SLEEP IN ADULTS. Epilepsy and paroxysmal conditions. 2013;5(3):59-64. (In Russ.)

Views: 488

ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)