Clinical and electroencephalographic features of sleep⁃related hypermotor epilepsy

Abstract

Objective To investigate clinical characteristics and diagnostic value of scalp video electroencephalography (VEEG) for sleep⁃related hypermotor epilepsy (SHE). Methods Total 32 patients with SHE from May 2014 to January 2020 were collected, and their general clinical data, clinical semiology, interictal electroencephalography (EEG) and onset patterns of ictal EEG were analyzed. Results Ten patients (31.25%) showed abnormal signs on MRI. Patients were categorized according to their semiology patterns (SPs). One patient (3.13%) was classified as SP1 (elementary motor signs), 18 patients (56.25%) as SP2 (unnatural hypermotor movements), 6 patients (18.75%) as SP3 (integrated hypermotor movements), and 7 patients (21.88%) as SP4 (gestural behaviors with high emotional content). The positive finding in interictal and ictal EEG were seen in 81.25% (26/32) and 71.88% (23/32) of patients. EEG onset occured earlier than clinical seizure in 23 patients (71.88%). Among these 23 patients whose scalp EEG started earlier than clinical seizure, 14 patients (43.75%) had focal discharge, 8 patients (25%) had regional discharge, one patient (3.13%) had bilateral/extensive discharge. Among initial scalp EEG patterns with focal and regional discharge, low⁃voltage fast activity was the most common. In addition, 11 patients (34.38%) had EEG epileptiform discharges at the same brain region during the interictal and ictal EEG recording, which were constantly confined to 1 or 2 to 3 adjacent electrodes. Conclusions The rate of positive finding in imaging in patients with SHE is low. However, the symptomatic manifestations are specific. High ⁃ quality VEEG recording and interpretation play an important role in the diagnosis and management of SHE patients. Ictal EEG can provide the necessary lateralization and localization information for preoperative evaluation.

DOI:10.3969/j.issn.1672⁃6731.2020.11.008