Nocturnal paroxysmal dystonia due to a subfrontal cortical dysplasia

The nature and nosology of nocturnal paroxysmal dystonia (NPD) have been co ntroversial. Some authors consider it as a type of parasomnia, akin to nigh t terrors and the official Classification of Sleep Disorder includes NPD wi thin the parasomnias [1]. Others have opined for its epileptic nature, alth ough mainly on circumstantial evidence. The location of the epileptogenic a rea has been so far unknown. A child with NPD was studied extensively, and in spite of normal scalp EEGs, all of his attacks were shown to originate f rom his right orbitofrontal cortex. Surgical ablation of an unsuspected cor tical dysplastic lesion led to full control.