title: Sleep-related minor motor events in nocturnal frontal lobe epilepsy.
abstract: OBJECTIVE
  Nocturnal frontal lobe epilepsy (NFLE) is characterized by a wide spectrum of sleep-related motor manifestations of increasing complexity, ranging from major episodes to brief motor events (minor motor events, MMEs). NFLE patients may exhibit a large quantity of MMEs in the form of short-lasting stereotyped movements. Whereas major episodes are considered epileptiform manifestations, it remains unclear whether the MMEs are related to epileptiform discharges (EDs).
  
  
  METHODS
  To study the relation between EDs and the occurrence of MMEs, we report a detailed neurophysiolgical evaluation in NFLE subjects explored by using implanted electrodes.
  
  
  RESULTS
  The median value of ED-related movements was 71.8%. Motor expression in relation to epileptiform discharge was surprisingly variable; no peculiar expression of MMEs could be attributed to the presence of EDs.
  
  
  CONCLUSIONS
  Our data suggest that ED-associated MMEs are extremely polymorphous, and no univocal relation to EDs can be identified. We hypothesize that MMEs are not a direct effect of epileptiform discharge (i.e., not epileptic in origin), but the result of aspecific disinhibition of innate motor patterns. We warn clinicians that the epileptic nature of minimal motor phenomena in NFLE cannot be established on the clinical phenomenology of the event.
authors.affiliation: Sleep Medicine and Epilepsy Unit, IRCCS C. Mondino Institute of Neurology Foundation, Pavia, Italy. michele.terzaghi@mondino.it
authors.forename: Michele
authors.initials: M
authors.lastname: Terzaghi
authors.forename: Ivana
authors.initials: I
authors.lastname: Sartori
authors.forename: Roberto
authors.initials: R
authors.lastname: Mai
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
authors.forename: Stefano
authors.initials: S
authors.lastname: Francione
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
authors.forename: Laura
authors.initials: L
authors.lastname: Castana
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.forename: Giorgio
authors.initials: G
authors.lastname: LoRusso
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manni
authors.forename: Lino
authors.initials: L
authors.lastname: Nobili
mesh_terms: D000328:Adult; D002940:Circadian Rhythm / Q000502:physiology; D015897:Comorbidity; D003937:Diagnosis, Differential; D004567:Electrodes, Implanted; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D020183:Nocturnal Paroxysmal Dystonia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D017286:Polysomnography; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis* / Q000453:epidemiology; D019956:Stereotypic Movement Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D014743:Videotape Recording