Symptomatic nocturnal frontal lobe epilepsy

Nocturnal frontal lobe epilepsy (NFLE) is a disorder characterised by clusters of brief motor seizures during sleep, often without surface EEG epileptiform abnormalities’“. For these reasons, the prevalence of this disorder has probably been underestimated. Moreover, in the past, many patients with clusters of nocturnal motor attacks have been diagnosed as having nocturnal paroxysmal dystonia5, paroxysmal awakenings6 or episodic nocturnal wanderings’. At present, except for a case report of a patient with a ‘posttraumatic paroxysmal nocturnal hemidystonia’8, all the patients described in the literature with abnormal motor and/or behavioral nocturnal phenomena had an idiopathic form of the disorder (i.e. absence of aetiological evidence; normal neurological and neuroradiological examinations, and often an unequivocal genetic influence)‘-7. We studied, by means of nocturnal videopolysomnography, a 39-year-old man with a l4-year history of repeated brief nocturnal motor attacks who had never received a definite diagnosis. His electroclinical picture allowed the diagnosis of nocturnal frontal lobe epilepsy and was indistinguishable from those of typical idiopathic cases. Nevertheless, a magnetic resonance imaging study showed a voluminous cyst arachnoidea compressing the left frontal and temporai lobes. The compression of the frontal lobe, with the possible involvement of the orbitomesial regions, could be the aetiological factors of the nocturnal attacks of our patient.