EXCESSIVE DAYTIME SLEEPINESS IN NOCTURNAL FRONTAL-LOBE EPILEPSY - A CASE-REPORT

We present a 43-year-old patient who has had up to 15 frontal lobe sei zures nightly for 12 years. The patient had no complaints apart from e xcessive daytime sleepiness. Neurological and psychiatric examination as well as cerebral computed tomograph and magnetic resonance imaging were normal. After sleep deprivation an interictal electroencephalogra m demonstrated a recurrent excess of theta activity over the right fro ntal and frontopolar area. A cerebral PET study showed diminished gluc ose metabolism of the right cingular and frontomesial region. The slee p structure was extremely fragmented. There was an excessive reduction of slow-wave sleep and REM sleep. Carbamazepine therapy produced comp lete seizure control lasting a few weeks, followed by return of up to 8 seizures per night. Vigabatrin as add on therapy diminished the noct ural seizures to 1 to 3 per night.