Coexistence of epileptic nocturnal wanderings and an arachnoid cyst.
Episodic nocturnal wanderings (ENWs) have rarely been associated with gross abnormalities of brain structures. We describe the case of a patient with ENWs in coexistence with an arachnoid cyst (AC). The patient was a 15-year-old boy who presented with nocturnal attacks characterized by complex motor behaviors. An MRI revealed a left temporal cyst and a SPECT Tc99 scan showed left temporal hypoperfusion and bilateral frontal hyperperfusion, more evident on the right side. During an all-night polysomnographic recording with audiovisual monitoring, dystonic posture followed by sleepwalking-like behavior was documented. The sleepwalking-like behavior was preceded by a spike discharge over the left frontocentral region with contralateral projection and secondary generalization during stage 2 sleep. Treatment with levetiracetam produced a striking remission of seizures. This supports a conservative management of an AC, considering that it may be an incidental finding. In epileptic patients, an AC may not necessarily be related to the location of the seizure focus.
Jiménez-Genchi
Alejandro
A
Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Tlalpan, Mexico. jimalex@imp.edu.mx
Díaz-Galviz
John L
JL
García-Reyna
Juan Carlos
JC
Avila-Ordoñez
Mario U
MU
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D016080:Arachnoid Cysts / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004569:Electroencephalography / Q000379:methods; D017034:Epilepsy, Frontal Lobe / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D000077287:Levetiracetam; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D017286:Polysomnography / Q000379:methods; D013009:Somnambulism / Q000150:complications* / Q000188:drug therapy; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D000077287:Levetiracetam; D014635:Valproic Acid; D010889:Piracetam
Clin Neurophysiol. 2000 Sep;111 Suppl 2:S129-35
10996566
Ann Neurol. 1977 Jul;2(1):30-5
900905
J Neuropathol Exp Neurol. 1981 Jan;40(1):61-83
7205328
Brain. 1999 Jun;122 ( Pt 6):1017-31
10356056
Neurosurg Rev. 1995;18(3):173-81
8570064
Sleep. 1995 Nov;18(9):749-56
8638067
Epilepsia. 1997 Oct;38(10):1098-102
9579956
Neurosurgery. 1992 Nov;31(5):940-4
1436421