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Klinische Neurophysiologie 2016; 47(03): 117-124
DOI: 10.1055/s-0042-110083
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

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

Non-REM Parasomnia or Frontal Lobe Epilepsy – Why is a Close Look So Important?
A. Heidbreder
1   Department für Neurologie, Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Universitätsklinikum Münster
,
G. Möddel
1   Department für Neurologie, Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Universitätsklinikum Münster
› Author Affiliations
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Publication History

Publication Date:
27 July 2016 (online)

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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
 

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