All data were retrospectively reviewed until last contact or death. The lifetime rate of sleep seizures was independently assessed by BM and LD on the basis of the clinical records doubtful cases were discussed and cases were only included when there was agreement. The agreement required for the final diagnosis was 100% otherwise these cases were considered doubtful and not included in the study.įurther inclusion criteria were: ≥90% of seizures occurring during sleep and within at least one year of follow-up. All cases with VPSG recordings of stereotyped PA that were not associated with major ictal events were carefully reviewed and discussed collegially the follow-up data were also considered, when available. Three experts in sleep medicine and epileptology (PT, FP, FB) confirmed the final diagnosis. Patients were eligible if they were diagnosed with NFLE, according to the following criteria: (1) a personal history of motor events arising predominantly from sleep, suggestive of a primary or secondary involvement of frontal lobe structures (2) video-polysomnographic recording of one hyperkinetic/asymmetric tonic-dystonic episode or at least two stereotyped paroxysmal arousals (PA). Cohort identification and data collection The aim of the present study was to assess the incidence of SUDEP retrospectively in a cohort of patients with NFLE, strictly defined as having more than 90% of seizures during sleep.Ģ.2. Based on these assumptions, people with NFLE might be at higher risk of SUDEP. Nocturnal frontal lobe epilepsy (NFLE) is a syndrome in which seizures occur mostly or exclusively during sleep and tend to be very frequent, occurring up to dozens of times per night. Accordingly, a recent study suggested that a history of nocturnal seizures might be an independent risk factor for SUDEP. Being found dead in bed is very common, especially in a prone position, presumably meaning that deaths occur preferentially during sleep, and the vast majority of the SUDEP cases recorded in video electroencephalography (EEG) monitoring units occurred at night. A terminal seizure appears to be almost universal in the witnessed episodes and when the circumstances of death are reliably recreated. However, epidemiological studies have pointed to a number of risk factors and precipitating situational circumstances. The pathogenic mechanisms underlying sudden unexpected death in epilepsy (SUDEP) have not yet been unravelled.
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