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Case 26 - Bad dreams

from Part V - Sleep-related epilepsy

Published online by Cambridge University Press:  10 November 2010

Antonio Culebras
Affiliation:
Upstate Medical University, New York
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Summary

This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 54-year-old man who reported that he had been having problems with his sleep for the previous 20 years. He said he had "bad dreams". A detailed neurological examination was completely normal. Cardiac and respiratory examinations were also normal. Overnight video-polysomnography (PSG) was planned. EEG showed occasional 1-second or so runs of moderate amplitude (2-5 Hz) slowing in either temporo-frontal region during early drowsiness. The episodes were thought to be frontal lobe seizures leading to a diagnosis of nocturnal frontal lobe epilepsy (NFLE). The diagnosis was NFLE with central sleep apnea (due to seizures). The differential diagnosis of these nocturnal events includes NREM-sleep-arousal parasomnias, REM-sleep behavior disorder (RBD) and psychogenic disorders. The video-PSG and the home study were very helpful in the diagnosis of this patient.
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Chapter
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Case Studies in Sleep Neurology
Common and Uncommon Presentations
, pp. 178 - 184
Publisher: Cambridge University Press
Print publication year: 2010

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