NREM Parasomnias: An Important Comorbidity in Epilepsy Patients of Pediatric Age

Objectives: We here aimed to investigate our pediatric group of patients to reveal the comorbidity of epilepsy and non-rapid eye movement (NREM) parasomnias and their clinical and polysomnographic characteristics.Methods: We retrospectively investigated all patients at the age of 18 or younger internalized within the last two years patients for a full night polysomnographic evaluation in our Sleep and Wake Disorders Unit. The diagnosis of epilepsy was made on the basis of clinical findings and electroencephalography findings; and the diagnosis of NREM parasomnia was made according to the International Classification of Sleep Disorders.Results: A total of 29 male (67.4%) and 14 female (32.6%) patients were investigated. Nineteen (44.2%) out of 43 patients were diagnosed as epilepsy. Nine (47.4%) of the patients with epilepsy also had delta-alpha paroxysms (DAP) and partial wakefulness during sleep – which are the characteristics polysomnographic features of NREM parasomnias.Conclusion: We observed a high comorbidity of epilepsy and NREM parasomnia in pediatric group of patients investigated in our sleepcenter. The arousal parasomnias are increasingly being reported to be more common in patients with epilepsy, probably due to shared commonphysiopathological mechanism characterized by pathological arousals originating in abnormal thalamo-cortical circuits produced by the central pattern generators

Epilepsy in vacuolating megalencephalic leukoencephalopathy with subcortical cysts

AbstractVacuolating megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a disorder characterised by acquired macrocephaly, developmental motor delay of varying degrees, slowly progressive cerebellar and pyramidal signs, and initially preserved intellectual function. More than 60% of the published cases had epileptic seizures.In this study, we analysed the seizures and EEG findings of nine patients with MLC. Six patients (66.6%) with moderate to severe neurological impairment had epilepsy, four with partial and two with generalised seizures. The EEG of five epileptic patients revealed epileptogenic foci over the temporal, frontal and parietal regions with variable predominance during waking and sleep. The facilitation of spike-and-wave paroxysms by eye closure, by intermittent photic stimulation and by hyperventilation were determined in four patients. Four patients also showed abnormalities in the background activity. In conclusion, we think that epilepsy is a significant component of MLC compared to the other leukodystrophies. The elucidation of the underlying molecular defect may explain the unusual pathogenetic relation between this leukoencephalopathy and the associated seizures