Movement disorders in steep: Guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep

Seizures, namely in certain epileptic conditions, may be precipitated by steep. Nocturnal frontal Lobe epilepsy seizures, characterized by bizarre motor behaviour and autonomic activation, appear almost exclusively during steep. The differential diagnosis between this condition and steep-related non-epileptic paroxysmal motor phenomena, in particular the parasomnias, is arduous. Moreover, accepted criteria for the diagnosis of nocturnal frontal lobe seizures are tacking and even ictal scalp EEG recording could fail to disclose paroxysmal abnormalities. The clinical and polygraphic features of the different types of seizures in nocturnal frontal lobe epilepsy and of the more common non-epileptic paroxysmal events during steep are described. The main differentiating features characterizing nocturnal frontal seizures are: onset at any age, several attacks per night at any time during the night, brief duration (s) with stereotyped motor pattern. As video-polysomnographic recordings of the attack, the gold-standard for diagnosis, are expensive and not readily available everywhere, home-made video recordings may be helpful. Further investigations on pathophysiology, genetics and epidemiology are needed to clarify the relationship between epileptic and non-epileptic steep related paroxysmal phenomena. (c) 2007 Elsevier Ltd. ALL rights reserved.