Tonic asymmetric partial seizures during sleep

R. Amerio, F. Bisulli, A. Cerullo, M. P. Valenti, G. D. Andrea, P. Tinuper

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Abstract

Objective The ictal semeiology of noctural paroxysmal attacks is often vague because detailed descriptions are obviously difficult. In these cases, only videopolygraphic recordings allow us to identify and classify these attacks properly. Methods and results We describe a 27-year-old man with no family history of epilepsy. Since the age of 26 he has presented nocturnal seizures described as tonic-clonic convulsions, many times a week. Nocturnal video-polygraphic recordings shows a different semeiological patten: the patient abruptly wakes up, then a tonic asymmetric contraction of the limbs occurs, more evident on the right arm, without loss of consciousness. Ictal EEG shows a slow amplitude fast activity for a few seconds on the vertex and on the anterior regions following a K-complex coinciding with the tonic contraction. We also recorded many minor sterotyped episodes characterized by minimal asymmetric tonic contraction of the arms always more evident on the right side. All the minor attacks coincided with a K-complcx and sometimes they recurred periodically every 20-40 seconds. Neurological examination was normal. Brain MRI disclosed an arachnoid cyst of the cerebellum. Antiepileptic treatment partially reduced seizure frequency. Conclusions Video-polygraphic recordings of our patient's attacks allowed us to classify them as tonic asymmetric partial seizures problably arising from a supplementary motor area. Minor episodes, sometimes occurring periodically every 20-40 seconds, are initial fragments of the whole seizure. These clinical and neurophysiological features are typical of the well described nocturnal frontal lobe epilepsies.

Original languageEnglish
Pages (from-to)353
Number of pages1
JournalItalian Journal of Neurological Sciences
Volume20
Issue number5
Publication statusPublished - 1999

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ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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