This chapter discusses the case of a 55-year-old woman who reported that for the previous 6 years she had been having episodes at night where she had dreams that often had a fearful content. It presents the clinical history, examination, diagnosis, and the results of the procedures performed on the patient. On examination she was anxious and cried during the interview. The differential diagnosis of paroxysmal nocturnal events includes parasomnia, seizures during sleep or a psychogenic disturbance. Parasomnia classification is usually based on the sleep phase during which the parasomnia occurs. Seizures seen in nocturnal frontal lobe epilepsy (NFLE) are sleep-related seizures that may be difficult to distinguish from other paroxysmal events at night. This is because the motor activity and vocalization may resemble other paroxysmal events with features such as cycling movements of the lower limbs and because patients may be partially responsive during the seizures.

This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 54-year-old man who reported that he had been having problems with his sleep for the previous 20 years. He said he had "bad dreams". A detailed neurological examination was completely normal. Cardiac and respiratory examinations were also normal. Overnight video-polysomnography (PSG) was planned. EEG showed occasional 1-second or so runs of moderate amplitude (2-5 Hz) slowing in either temporo-frontal region during early drowsiness. The episodes were thought to be frontal lobe seizures leading to a diagnosis of nocturnal frontal lobe epilepsy (NFLE). The diagnosis was NFLE with central sleep apnea (due to seizures). The differential diagnosis of these nocturnal events includes NREM-sleep-arousal parasomnias, REM-sleep behavior disorder (RBD) and psychogenic disorders. The video-PSG and the home study were very helpful in the diagnosis of this patient.

This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a man who presented with frequent episodes of sudden and unexplained arousals from nocturnal sleep. The sleep medicine specialist ordered a full-night video-polysomnography (PSG) recording including standard bipolar EEG, right and left electro-oculograms (EOGs), surface EMG of the mylohyoideus muscle, ECG, oro-nasal, thoracic and abdominal respirograms, and circulating oxyhemoglobin saturation. The specialist decided to withdraw clonazepam and advised the patient not to drive due to drowsiness until the results of the investigations became available and appropriate therapy was prescribed. The sleep medicine specialist established a diagnosis of nocturnal frontal lobe epilepsy (NFLE) based on historical features and video-PSG findings. Nocturnal frontal lobe epilepsy is a peculiar partial epilepsy whose clinical features comprise a spectrum of paroxysmal motor manifestations of variable duration and complexity, occurring mainly during sleep.