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

Paolo Tinuper, Federica Provini, Francesca Bisulli, Luca Vignatelli, Giuseppe Plazzi, Roberto Vetrugno, Pasquale Montagna, Elio Lugaresi

Research output: Contribution to journalArticlepeer-review


Seizures, namely in certain epileptic conditions, may be precipitated by sleep. Nocturnal frontal lobe epilepsy seizures, characterized by bizarre motor behaviour and autonomic activation, appear almost exclusively during sleep. The differential diagnosis between this condition and sleep-related non-epileptic paroxysmal motor phenomena, in particular the parasomnias, is arduous. Moreover, accepted criteria for the diagnosis of nocturnal frontal lobe seizures are lacking 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 sleep 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 sleep related paroxysmal phenomena.

Original languageEnglish
Pages (from-to)255-267
Number of pages13
JournalSleep Medicine Reviews
Issue number4
Publication statusPublished - Aug 2007


  • Differential diagnosis
  • Epilepsy
  • Nocturnal frontal lobe epilepsy
  • Parasomnias
  • Seizures during sleep
  • Video-polysomnography

ASJC Scopus subject areas

  • Clinical Neurology
  • Ophthalmology
  • Pulmonary and Respiratory Medicine
  • Neurology
  • Dentistry(all)

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