Prognosi dell'epilessia frontale notturna (EFN): Studio di follow-up a lungo termine

Purpose: This study analyses the clinical and prognostic features of 100 patients (pts) with nocturnal frontal lobe epilepsy (NFLE) after a long follow-up. Methods: We selected 100 pts with NFLE according to the following criteria: a history of nocturnal seizures with symptoms suggesting frontal lobe involvement, video-polysomnographic recording of at least one major episode (hypermotor or tonic seizures) or two stereotyped paroxysmal arousals, a follow-up period longer than 5 years and last visit within the last 24 months. All pts underwent a full clinical, neuroradiological and neurophysiological examination. On the basis of seizure frequency at the last visit our population was divided into two groups: pts with Negative Evolution (NE- seizure frequency varying from daily to pluriyearly:) and pts with Positive Evolution (PE- seizure-free for at least 1 year or with sporadic seizure: 42%). Results: The final population of 100 pts (62 males, 38 females) had a mean age at onset of epilepsy of 13.3 ± 10.4 yrs; all pts had a long period of follow-up (mean: 12.9 ± 6.9 yrs). Only ten patients had positive neuroimaging findings; our population included two nuclear families. Genetic tests done on 39 pts were negative. Most pts presented hypermotor seizures (64%), 28% presented tonic asymmetric seizures, and 6% presented both; 2% presented paroxysmal arousal only. Among the PE group,38 pts were seizure-free; the mean age at seizure disappearance was 33.6 ± 15.7 yrs. Among NE pts the mean age at onset of epilepsy was slightly lower than in PE pts (PE 16.5 ± 11.1 yrs vs NE 12.1 ± 9.1 yrs; p = 0.049). No significant differences were observed between the two groups in seizure type, personal history of febrile convulsions (FC), family history of FC, family history of epilepsy and parasomnias, status epilepticus, secondary generalization, seizures also in wakefulness or interictal epileptiform abnormalities. Conclusions: These preliminary data show significant differences between NE and PE pts only for earlier age at onset and high sezure frequency at onset in the NE group, that seems to be a negative prognostic factor.