Nocturnal frontal lobe epilepsy and the acetylcholine receptor

Luigi Ferini-Strambi, Veronica Sansoni, Romina Combi

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: Nocturnal frontal lobe epilepsy (NFLE) is an idiopathic partial epilepsy characterized by a wide spectrum of stereotyped motor manifestations, mostly occurring during non rapid eye movements sleep. NFLE is underdiagnosed since semiological similarities make it difficult to distinguish NFLE from parasomnias. In 1994, authors reported families with NFLE inherited as an autosomal dominant trait and they introduced the term of autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). A family history of possible NFLE is found in about 25% of cases. The genetic bases of the disease have been detected in a minority of cases. Mutations causing a gain of function of the neuronal nicotinic acetylcholine receptors were reported in 3 different subunits. REVIEW SUMMARY:: This review discusses the clinical aspects of NFLE and the diagnostic procedures. Furthermore, the genetic aspects are outlined. The main differentiating features characterizing NFLE are: (a) several attacks per night at any time during the night; (b) brief duration of the attacks; (c) stereotyped motor pattern. Nocturnal video-polysomnography is crucial for the diagnosis. Neurological examination in NFLE/ADNFLE is normal. About 30% of NFLE cases are resistant to antiepileptic drugs. Concerning the genetics, putative susceptibility nucleotide variations affecting the promoter of the CRH gene and altering the corticotrophin-releasing hormone levels have been reported in some NFLE patients. CONCLUSIONS:: Distinguishing NFLE seizures from paroxysmal nonepileptic sleep disorders is often difficult and sometimes impossible on clinical grounds alone. Nocturnal video-polysomnography is mandatory. Further genetic studies could help the diagnosis and treatment in NFLE patients.

Original languageEnglish
Pages (from-to)343-349
Number of pages7
JournalNeurologist
Volume18
Issue number6
DOIs
Publication statusPublished - Nov 2012

Keywords

  • corticotropin-releasing hormone
  • genetics
  • nicotinic acetylcholine receptor
  • nocturnal frontal lobe epilepsy
  • parasomnias

ASJC Scopus subject areas

  • Clinical Neurology

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