Non-REM-Parasomnie oder Frontallappenepilepsie – Warum sollte man genau hinschauen?

Zusammenfassung

Nächtliche Verhaltensauffälligkeiten betreffen ca. 4% aller Erwachsenen. Differenzialdiagnostisch kommen v. a. Parasomnien und schlafgebundene epileptische Anfälle in Betracht. Zu den Non-REM-Parasomnien gehören Schlafwandeln, verwirrtes Erwachen und Pavor nocturnus. Neben der Gefährdung durch die Attacken selbst (z. B. Unfälle) leiden Betroffene oft unter vermehrter Tagesschläfrigkeit. Die Therapie besteht in Verhaltensmaßnahmen (z. B. Schlafhygiene, antizipiertes Wecken), in schweren Fällen auch in medikamentöser Behandlung (z. B. Benzodiazepine). Nächtliche Anfälle sind bei fokalen Epilepsien häufig, besonders schwierig ist die Abgrenzung von Parasomnien gegen Frontallappenanfälle. Deren Semiologie beinhaltet u. a. hypermotorische Anfälle mit ausfahrenden, teils aggressiv anmutenden Automatismen. Die häufigste Ursache sind kortikale Dysplasien. Die Diagnostik ist häufig schwierig, da MRT und Routine-EEG oft nicht wegweisend sind. Goldstandard für die Diagnose ist die Video-EEG-Aufzeichnung typischer Attacken. Die Therapie orientiert sich an den Leitlinien zur Behandlung fokaler Epilepsien.

Abstract

Sleep-related attacks occur in 4% of the adult population. The differential diagnosis includes parasomnias and sleep-related epileptic seizures. Non-REM parasomnias are sub-classified as sleep walking, confusional arousals and sleep terrors. The attacks themselves may put patients at risk. In addition, many patients suffer from daytime sleepiness. Treatment includes behavioral measures such as sleep hygiene or anticipated awakening. In severe cases, drugs such as benzodiazepines may be used. Nocturnal seizures are common in patients with focal epilepsies. It is especially challenging to distinguish parasomnic attacks from frontal lobe seizures. The latter include hypermotor seizures with proximal, bizarre, sometimes violent automatisms. The most common cause of frontal lobe epilepsy is cortical dysplasia. The diagnosis may be challenging as routine MRI and EEG are often normal. As gold standard, typical attacks should be recorded on video EEG. Frontal lobe epilepsy is treated according to the common guidelines for focal epilepsies.

Schlüsselwörter

Parasomnie - Schlafwandeln - Frontallappenepilepsie - nächtliche Anfälle - Video-EEG

Key words

parasomnia - sleep walking - frontal lobe epilepsy - nocturnal seizures - video-EEG monitoring

• Literatur

• 1 Bjorvatn B, Gronli J, Pallesen S. Prevalence and incidence of parasomnias in the general population. Sleep Med 2010; 11: 1031-1034
• 2 Zadra A, Desautels A, Petit D et al. Somnambulism: clinical aspects and pathophysiological hypotheses. Lancet Neurol 2013; 12: 285-294
• 3 Postuma RB, Gagnon JF, Montplaisir J. RBD as a biomarker for neurodegeneration: the past 10 years. Sleep Med 2012; published online Oct 8
• 4 Petit D, Touchette E, Tremblay RE et al. Dyssomnias and parasomnias in early childhood. Pediatrics 2007; 119: e1016-e1025
• 5 Hublin C, Kaprio J, Partinen M et al. Prevalence and genetics of sleepwalking: a population-based twin study. Neurology 1997; 48: 177-181
• 6 Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry 1999; 60: 268-276
• 7 Ohayon MM, Mahowald MW, Dauvilliers Y et al. Prevalence and comorbidity of nocturnal wandering in the U. S. adult general population. Neurology 2012; 78: 1583-1589
• 8 Kales A, Soldatos CR, Bixler EO et al. Hereditary factors in sleepwalking and night terrors. Br J Psychiatry 1980; 137: 111-118
• 9 Heidbreder A, Frauscher B, Mitterling T et al. Not Only Sleepwalking But NREM Parasomnia Irrespective of the Type Is Associated with HLA DQB1*05:01. J Clin Sleep Med 2016; 12: 565-570
• 10 Cartwright R. Sleepwalking violence: a sleep disorder, a legal dilemma, and a psychological challenge. Am J Psychiatry 2004; 161: 1149-1158
• 11 American Academy of Sleep Medicine. International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. 3^rd (ed.). Westchester, IL: American Academy of Sleep Medicine; 2014
• 12 Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep 2002; 25: 120-138
• 13 Tinuper P, Provini F, Bisulli F et al. Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep. Sleep Med Rev 2007; 11: 255-267
• 14 Derry CP, Davey M, Johns M et al. Distinguishing sleep disorders from seizures: diagnosing bumps in the night. Arch Neurol 2006; 63: 705-709
• 15 Zadra A, Pilon M, Montplaisir J. Polysomnographic diagnosis of sleepwalking: effects of sleep deprivation. Ann Neurol 2008; 63: 513-519
• 16 Joncas S, Zadra A, Paquet J et al. The value of sleep deprivation as a diagnostic tool in adult sleepwalkers. Neurology 2002; 58: 936-940
• 17 Pilon M, Montplaisir J, Zadra A. Precipitating factors of somnambulism: impact of sleep deprivation and forced arousals. Neurology 2008; 70: 2284-2290
• 18 Jacobson A, Kales A, Lehmann D et al. Somnambulism: all-night electroencephalographic studies. Science 1965; 148: 975-977
• 19 Jaar O, Pilon M, Carrier J et al. Analysis of slow-wave activity and slow-wave oscillations prior to somnambulism. Sleep 2010; 33: 1511-1516
• 20 Gaudreau H, Joncas S, Zadra A et al. Dynamics of slow-wave activity during the NREM sleep of sleepwalkers and control subjects. Sleep 2000; 23: 755-760
• 21 Blatt I, Peled R, Gadoth N et al. The value of sleep recording in evaluating somnambulism in young adults. Electroencephalogr Clin Neurophysiol 1991; 78: 407-412
• 22 Espa F, Ondze B, Deglise P et al. Sleep architecture, slow wave activity, and sleep spindles in adult patients with sleepwalking and sleep terrors. Clin Neurophysiol 2000; 111: 929-939
• 23 Guilleminault C, Poyares D, Aftab FA et al. Sleep and wakefulness in somnambulism: a spectral analysis study. J Psychosom Res 2001; 51: 411-416
• 24 Hurwitz TD, Mahowald MW, Schenck CH et al. A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terror. J Nerv Ment Dis 1991; 179: 228-233
• 25 Hauri PJ, Silber MH, Boeve BF. The treatment of parasomnias with hypnosis: a 5-year follow-up study. J Clin Sleep Med 2007; 3: 369-373
• 26 Owens LJ, France KG, Wiggs L. Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: a review. Sleep Med Rev 1999; 3: 281-302
• 27 Guilleminault C, Kirisoglu C, Bao G et al. Adult chronic sleepwalking and its treatment based on polysomnography. Brain 2005; 128: 1062-1069
• 28 Cooper AJ. Treatment of coexistent night-terrors and somnambulism in adults with imipramine and diazepam. J Clin Psychiatry 1987; 48: 209-210
• 29 Schenck CH, Mahowald MW. Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med 1996; 100: 333-337
• 30 Kavey 1 NB, Whyte J, Resor Jr SR et al. Somnambulism in adults. Neurology 1990; 40: 749-752
• 31 Maselli 1 RA, Rosenberg RS, Spire JP. Episodic nocturnal wanderings in non-epileptic young patients. Sleep 1988; 11: 156-161
• 32 Jobst BC, Siegel AM, Thadani VM et al. Intractable seizures of frontal lobe origin: clinical characteristics, localizing signs, and results of surgery. Epilepsia 2000; 41: 1139-1152
• 33 Nobili L, Francione S, Mai R et al. Surgical treatment of drug-resistant nocturnal frontal lobe epilepsy. Brain 2007; 130: 561-573
• 34 Kotagal P, Arunkumar GS. Lateral frontal lobe seizures. Epilepsia 1998; 39: 62-68
• 35 So NK. Mesial frontal epilepsy. Epilepsia 1998; 39: 49-61
• 36 Salanova V, Morris 3rd HH, Van Ness PC et al. Comparison of scalp electroencephalogram with subdural electrocorticogram recordings and functional mapping in frontal lobe epilepsy. Arch Neurol 1993; 50: 294-299
• 37 Bautista RE, Spencer DD, Spencer SS. EEG findings in frontal lobe epilepsies. Neurology 1998; 50: 1765-1771
• 38 Swartz BE, Walsh GO, Delgado-Escueta AV et al. Surface ictal electroencephalographic patterns in frontal vs temporal lobe epilepsy. Can J Neurol Sci 1991; 18: 649-662
• 39 Kellinghaus C, Lüders HO. Frontal lobe epilepsy. Epileptic Disord 004 Dec 6: 223-239
• 40 Janszky J, Jokeit H, Schulz R et al. EEG predicts surgical outcome in lesional frontal lobe epilepsy. Neurology 2000; 5: 1470-1476
• 41 Jeha LE, Najm I, Bingaman W et al. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain 2007; 130: 574-584
• 42 Frater JL, Prayson RA, Morris III HH et al. Surgical pathologic findings of extratemporal-based intractable epilepsy: a study of 133 consecutive resections. Arch Pathol Lab Med 2000; 124: 545-549
• 43 Wolf HK, Zentner J, Hufnagel A et al. Surgical pathology of chronic epileptic seizure disorders: experience with 63 specimens from extratemporal corticectomies, lobectomies and functional hemispherectomies. Acta Neuropathol 1993; 86: 466-472
• 44 Schramm J, Kral T, Kurthen M et al. Surgery to treat focal frontal lobe epilepsy in adults. Neurosurgery 2002; 51: 644-654
• 45 Blümcke I, Thom M, Aronica E et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 2011; 52: 158-174
• 46 Steinlein OK, Mulley JC, Propping P et al. A missense mutation in the neuronal nicotinic acetylcholine receptor alpha 4 subunit is associated with autosomal dominant nocturnal frontal lobe epilepsy. Nat Genet 1995; 11: 201-203
• 47 Heron SE, Smith KR, Bahlo M et al. Missense mutations in the sodium-gated potassium channel gene KCNT1 cause severe autosomal dominant nocturnal frontal lobe epilepsy. Nat Genet 2012; 44: 1188-1190
• 48 Møller RS, Heron SE, Larsen LH et al. Mutations in KCNT1 cause a spectrum of focal epilepsies. Epilepsia 2015; 56: e114-e120
• 49 Picard F, Makrythanasis P, Navarro V et al. DEPDC5 mutations in families presenting as autosomal dominant nocturnal frontal lobe epilepsy. Neurology 2014; 82: 2101-2106
• 50 Quesney LF. Preoperative electroencephalographic investigation in frontal lobe epilepsy: electroencephalographic and electrocorticographic recordings. Can J Neurol Sci 1991; 18: 559-563
• 51 Quesney LF, Constain M, Fish DR et al. The clinical differentiation of seizures arising in the parasagittal and anterolaterodorsal frontal convexities. Arch Neurol 1990; 47: 677-679
• 52 Williamson PD. Frontal lobe epilepsy. Some clinical characteristics. Adv Neurol 1995; 66 127–150, 150-152
• 53 Laskowitz DT, Sperling MR, French JA et al. The syndrome of frontal lobe epilepsy: characteristics and surgical management. Neurology 1995; 45: 780-787
• 54 Morris 3rd HH, Dinner DS, Lüders H et al. Supplementary motor seizures: clinical and electroencephalographic findings. Neurology 1988; 38: 1075-1082
• 55 Wellmer J, Quesada CM, Rothe L et al. Proposal for a magnetic resonance imaging protocol for the detection of epileptogenic lesions at early outpatient stages. Epilepsia 2013; 54: 1977-1987
• 56 Urbach H. How to perform MRI. In: Urbach H. (Ed.) MRI in epilepsy. Springer; 2013: 29-36
• 57 Von Oertzen J, Urbach H, Jungbluth S et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry 2002; 73: 643-647
• 58 Wilke M, Kassubek J, Ziyeh S et al. Automated detection of gray matter malformations using optimized voxel-based morphometry: a systematic approach. Neuroimage 2003; 20: 330-343
• 59 Van Paesschen W, Dupont P, Sunaert S et al. The use of SPECT and PET in routine clinical practice in epilepsy. Curr Opin Neurol 2007; 20: 194-202
• 60 Mu J, Rampp S, Carrette E et al. Clinical relevance of source location in frontal lobe epilepsy and prediction of postoperative long-term outcome. Seizure 2014; 23: 553-559
• 61 Aydin Ü, Vorwerk J, Dümpelmann M et al. Combined EEG/MEG can outperform single modality EEG or MEG source reconstruction in presurgical epilepsy diagnosis. PLoS One 2015; 10: e0118753
• 62 Elsharkawy AE, Alabbasi AH, Pannek H et al. Outcome of frontal lobe epilepsy surgery in adults. Epilepsy Res 2008; 81: 97-106
• 63 McGonigal A, Bartolomei F, Gavaret M et al. Gamma knife radiosurgery of paracentral epilepsy. Stereotact Funct Neurosurg 2014; 92: 346-353
• 64 Wellmer J, Kopitzki K, Voges J. Lesion focused stereotactic thermo-coagulation of focal cortical dysplasia IIB: a new approach to epilepsy surgery?. Seizure 2014; 23: 475-478