Abstracts

Rationale: Nocturnal Epilepsy (NE) is a condition that is primarily characterised by seizures exclusively or predominantly during sleep. Although frontal lobe is known to be the main epileptogenic zone and there are familial cases, seizures may arise from other areas with different etiologies. We sought to search for the demographic, aetiological and clinical features of NE for better diagnosis and treatment. Methods: Patients with NE ( ?70% of seizures occur during sleep) who admitted to the university hospital and followed in the epilepsy outpatient clinic between January 1999- December 2010 were included in this study. Patients with idiopathic generalized epilepsy and benign idiopathic partial childhood epilepsies with known relationship to sleep were excluded. All patients underwent physical and neurological examinations, interictal EEG during wakefulness and sleep and MRI. Neuropsychological examination, ictal video EEG recordings and FDG-PET were performed if patients were surgical candidates. The data related to history of febrile seizures (FS), seizure type, EEG and MRI abnormality, therapeutic response and demographic information were analyzed statistically. Results: Among 910 patients, 90 patients were identified within the age range of 5-84 yrs (mean 31,2 14,1) where 54% was female. Mean seizure onset was 13,8 11,8 years. Seizures occur exclusively during sleep in 51% of patients. In 47,1% of patients they were intractable and in 40% well controlled. MRI revealed a structural lesion in 61,2% where majority localized in temporal lobe (TL) with favorable outcome and almost half of them at right the other half, at left hemispheric lateralization. Lesions detected were hippocampal sclerosis (24%), tumour (12%) and cortical dysplasia(10%). Fifty-four % of patients were on monotherapy, the most common drug was carbamazepine (p<0,001) and 30 % underwent surgery where 65% had TL epilepsy (p=0,0014). History of FS, abnormal EEG, MRI findings and therapeutic response showed no statistical correlation. EEG pathology was more common in TL. Follow-up duration was statistically shorter in refractory group than the others (p<0,001). Conclusions: This study suggested that almost half of the patients with NE were intractable and CBZ was the most common drug in monotherapy. Frontal lobe is less involved than TL where MR was negative in majority of them.