EPILEPTIC SEIZURES IN SUBJECTS PREVIOUSLY AFFECTED BY DISORDERS OF AROUSAL

Six patients (3M, 3F, mean age 17.3 yrs) presenting different types of evolution from disorders of arousal to epilepsy are described. All su bjects during their childhood had been diagnosed in a sleep center as affected by sleep-walking (three cases) and night terrors (the other t hree). Successively they developed nocturnal events different from tho se previously exhibited and consisting of clear epileptic seizures, ge neralized tonic-clonic in one case and complex partial in five cases. Nocturnal monitoring allowed recognition of clear interictal paroxysma l activity in three patients, while ictal events were recorded in the remaining three. Anticonvulsant treatment (carbamazepine in five patie nts, phenytoin in one patient) led to the resolution of the ictal even ts in all cases. The fact that both disorders of arousal and epilepsy are strictly related to sleep and often share common features such as age range of onset and precipitating factors, suggests the existence o f common functional substrates identifiable in constitutional maturati ve and biologic factors. The possible occurrence of seizures in subjec ts exibiting parasomnia during their childhood has to be considered in patients with familial history of epilepsy and in all doubtful cases.