title: Sleep Related Hypermotor Seizures with a Right Parietal Onset.
abstract: Nocturnal frontal lobe epilepsy (NFLE) is a syndrome characterized by the occurrence of sleep related seizures of variable complexity and duration. Hypermotor seizures (HMS) represent a classic manifestation of this syndrome, associated with a perturbation of the ventromesial frontal cortex and anterior cingulate gyrus regions. Nevertheless, in recent years, reports have showed that the seizure onset zone (SOZ) need not be of frontal origin to generate HMS. Here we report an unusual case of a patient presenting with a seven-year history of drug-resistant sleep related HMS arising from the mesial parietal region. The presence of an infrequent feeling of levitation before the HMS was key to suspecting a subtle focal cortical dysplasia in the right precuneus region. A stereo-EEG investigation confirmed the extra-frontal seizure onset of the HMS and highlighted the interrelationship between unstable sleep and seizure precipitation.
authors.affiliation: Center of Sleep Medicine, Centre for Epilepsy Surgery "C. Munari," Department of Neurosciences, Hospital Niguarda, Milan, Italy.
authors.forename: Steve A
authors.initials: SA
authors.lastname: Gibbs
authors.affiliation: Center of Sleep Medicine, Centre for Epilepsy Surgery "C. Munari," Department of Neurosciences, Hospital Niguarda, Milan, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Figorilli
authors.affiliation: Center of Sleep Medicine, Centre for Epilepsy Surgery "C. Munari," Department of Neurosciences, Hospital Niguarda, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casaceli
authors.affiliation: Center of Sleep Medicine, Centre for Epilepsy Surgery "C. Munari," Department of Neurosciences, Hospital Niguarda, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Proserpio
authors.affiliation: Center of Sleep Medicine, Centre for Epilepsy Surgery "C. Munari," Department of Neurosciences, Hospital Niguarda, Milan, Italy.
authors.forename: Lino
authors.initials: L
authors.lastname: Nobili
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D004569:Electroencephalography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010296:Parietal Lobe / Q000473:pathology*; D017286:Polysomnography; D012640:Seizures / Q000175:diagnosis*
keywords: hypermotor seizure; nocturnal frontal lobe epilepsy; parietal lobe epilepsy; paroxysmal arousal; sleep