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Nocturnal frontal lobe epilepsy — SCE Neurology MCQ

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ModerateEpilepsyNocturnal frontal lobe epilepsySCE Neurology

A 36-year-old woman presented with brief violent hypermotor spells arising from sleep several times nightly. On examination, examination was normal and events were stereotyped with rapid recovery. Initial investigations showed: video-EEG showed subtle frontal ictal rhythm obscured by movement artefact. What is the most likely diagnosis?

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Correct answer: A — Nocturnal frontal lobe epilepsy

Nocturnal frontal lobe epilepsy is the best answer because the vignette describes Nocturnal frontal lobe epilepsy: brief stereotyped hypermotor nocturnal attacks suggest frontal lobe epilepsy. Epilepsia partialis continua is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Focal motor seizure with Todd's paresis and Dravet syndrome are less appropriate because they would require different localisation, timing or test findings; Autoimmune limbic encephalitis with seizures would fit a different syndrome. Clinical pearl: parasomnias are usually less stereotyped and less frequent per night.

Reference: NICE NG217; BNF; DVLA Assessing fitness to drive