SUMMARY. Purpose: To test the usefulness of the FLEP scale in diagnosing nocturnal frontal lobe epilepsy (NFLE), arousal parasomnias, and. The Frontal Lobe Epilepsy and Parasomnias (FLEP) Scale. Clinical Feature. Score. Age at onset. At what age did the patient have their first clinical event? < 55y. Created by Derry and colleagues [1], the item FLEP scale is designed to aid clinicians in distinguishing frontal lobe seizures from parasomnias.

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Am J Psychiatry ; Distinguishing sleep disorders from seizures: In nocturnal frontal lobe epilepsy NFLEthe unusual seizure features often lead to diagnostic confusion with nonepileptic parasomnias; video-electroencephalography monitoring is usually required to make the svale.

Scale development and structure. The sensitivity of 1 and specificity of 0.

These features fleo included in the scale based on their discriminatory value. Sign in to save your search Sign in to your personal account.

Table 2 from Epilepsy and sleep. – Semantic Scholar

f,ep Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account. EEG montage channels 12—19 shows with a run of sharp waves during the event episode. Nocturnal frontal lobe epilepsy sporadic, familialNocturnal paroxysmal dystonia, Paroxysmal arousals, Nocturnal temporal lobe epilepsy, Video-polysomnography, Anticonvulsant therapy 1. Both forms of Sczle need to be distinguished from para-somnias, nocturnal temporal lobe epilepsy, and other nocturnal disorders.

In regards to the differential diagnosis, there was no evidence supporting the diagnosis of sleep-related myoclonic seizures, or any form of sleep-related benign myoclonus condition.

Seizures Scalf for additional papers on this topic. NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: However, the absence of stereotypy of PAs, despite the morphological and topographic similarity of the epileptic EEG discharges, might suggest that the clinical features of PAs depend not only on the site of epileptic discharge but also on other variables such as the level of arousal from which the epileptic discharges occurred and the patient’s body position [19].


Nocturnal frontal lobe epilepsy: An overnight, hospital-based, vPSG monitoring, utilizing standard recording and scoring methods [10], was then performed on these patients after discontinuation of antiepileptic drugs for at least one day, except patient 8 who had recurrent attacks several times daily in wakefulness scsle sleep beginning shortly on the fpep of medication discontinuation.

Waking EEG was normal in all patients, and epileptiform abnormalities were documented during sleep in two patients. Scalr those patients with less frequent events, it will often not be possible to capture an event during a monitoring period, in which case the investigation will not usually clarify the diagnosis. Dcale the interviews, clinical information was obtained from the patient and a witness usually the patient’s partner, relative, or parent in the case of a child.

Subjects with NFLE and atypical parasomnias confirmed by video-EEG or PSG monitoring were recruited retrospectively from a review of existing medical databases and records covering a year period. Get free access to newly published articles Create a personal account or sign in to: Clinical features that sxale be useful in distinguishing nocturnal frontal lobe epilepsy NFLE from parasomnias.

Differentiating parasomnias from nocturnal seizures. In the group of severely affected patients, recording events during video-EEG monitoring may still be difficult or impossible owing to the unpredictable nature of the attacks. DuncanSamuel F.

The electrocardiogram channel 11 shows an increase in heart rate during the episode attack.

This may reduce the requirement for tertiary referral and extensive inpatient monitoring. The high rate of sustained treatment efficacy is gratifying for the patients once they are informed of their disordertheir families, and their physicians. Administrative, technical, and material support: Christopher Paul DerryA.

Eighty-four subjects who met the entry criteria for the study were identified. In addition, access to video-EEG and PSG monitoring services varies widely in different regions, and for many patients, these investigations are not available.

Epilepsy and sleep.

The nocturnal paroxysmal episodes had been present for up to 18 yrs mean 9. Create a free personal account to access your subscriptions, sign up for alerts, and more. The long duration for diagnosing NFLE a mean 3.

Copyright American Medical Association.

Table 4 from Nocturnal epilepsy in adults. – Semantic Scholar

Citations Publications citing this paper. The main weakness of the study is the retrospective nature of recruitment for the monitored group of patients. Six PA episodes were recorded from two patients, lasting a mean of Prolonged episodes of PAs were followed by brief dystonic movements of the limbs and pelvic thrusting or fully developed bilateral hypertonic-hyperkinetic activity. Neurology ;42 7 Suppl. A further potential criticism relates to the absence of confirmatory video-EEG monitoring in the consecutive series of typical parasomnias.


All episodes occurred during NREM sleep. In regards to any possible differences in epidemiologic frequency of NFLE in Taiwanese and other Asians compared to Caucasian populations, a PubMed search did not reveal any prevalence data for any of these groups, most likely because relatively few NFLE cases have been reported. Recent studies have provided new insights into the links between the disorders that may facilitate differential diagnosis and treatment but may also improve our understanding of underlying pathophysiological scake.

Diagnosing Bumps in the Night. Sleep-related hyperkinetic seizures of temporal lobe origin were documented in three patients by means of long-term stereo-EEG investigations and surgical outcome [7]. This confusion arises through the similarities in the clinical features of these conditions and the fact that in both conditions magnetic resonance imaging and interictal EEG results are often normal.

Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases

None of the patients had any adverse effects or complaints related to treatment. From This Paper Figures, tables, and topics from this paper. Lino Nobili Sleep medicine reviews All patients with confirmed diagnoses who could still be contacted were approached flfp participation as well as all new cases identified during admission for investigation during a 2-year period.

Husain and Saurabh R. While typical parasomnias are often not a significant clinical problem, individuals with severe or frequent events often seek medical attention.