Case Report, J Sleep Disor Treat Care Vol: 6 Issue: 3
Improved Sleep Quality in Patients Affected by Nocturnal Frontal Lobe Epilepsy (NFLE) Treated with Lacosamide: A Two Cases Report
*Corresponding Author : Marilena Mangiardi, Neurologist MD
Department of Neurology and Neurophysiology, MG Vannini Hospital, Via di Acqua Bullicante 4 00177, Rome Italy
E-mail: marilenamangiard[email protected]
Received: May 18, 2017 Accepted: June 01, 2017 Published: June 08, 2017
Citation: Mangiardi M, Alfano G (2017) Improved Sleep Quality in Patients Affected by Nocturnal Frontal Lobe Epilepsy (NFLE) Treated with Lacosamide: A Two Cases Report. J Sleep Disord: Treat Care 6:3. doi: 10.4172/2325-9639.1000195
Nocturnal Frontal Lobe Epilepsy (NFLE) is a form of focal epilepsy with heterogeneous clinical presentation of morpheic seizures that tend to cluster overnight, with a good response to carbamazepine (CBZ). We report two cases of NFLE patients associated with sleep disorders, successfully treated with lacosamide 200 mg/day. We hypothesized that lacosamide, in relation to its multiple action mechanisms, can have positive effects not only on seizures control but also on sleep disorders associated with them.
Keywords: Nocturnal frontal lobe epilepsy; Sleep; Sleep disorders
Nocturnal Frontal Lobe Epilepsy (NFLE) is a form of focal epilepsy with heterogeneous clinical presentation of morpheic seizures that tend to cluster overnight . Often recording EEG, both in the ictal and interictal stages, is negative for epileptiform activities. In most cases a good response to carbamazepine (CBZ) was described but not to other AEDS. Related to the clinical presentation (stereotyped dystonic/dyskinetic features of attacks), the almost absence of EEG abnormalities and the recurrence of episodes during sleep, the authors debated the epileptic origin of the NFLE, considering it as a sleep motor disorder with an unclear pathophysiology . Furthermore, due to the recurrence of the motor events during sleep, NFLE patients may complain of daytime sleepiness and/or other sleep disorders [3,4].
We report two clinical cases of patients affected by NFLE and sleep disorders successfully treated with lacosamide (LCM).
A 26-year-old man with multiple-frequency night-time seizures characterized by stereotyped ballistic upper right and chewing gait movements lasting a few minutes, associated with explosive vocalization, sometimes followed by secondary generalization. The patient also reported frequent nightmares, fragmented nocturnal sleep and daytime sleepiness, which could negatively affect working and family life.
Family history and brain magnetic resonance imaging (MRI) was negative; mutations in nAChR were undetected. Ictal and interictal scalp EEG revealed nonspecific anterior slow discharges.
Video-polysomnography showed an increase in sleep fragmentation and high percentage of waking with a simultaneous decrease in the percentage of deep sleep and the REM phase.
Seizures were refractory to high doses of carbamazepine (1200 mg/ day). Therefore, due to the onset of side effects and poor clinical improvement, the patient slowly withdrew from carbamazepine and started lacosamide until the dosage of 100mg BD.
After 6 months of follow-up, the patient had about two nocturnal seizures per month. After 12 months follow-up, it was seizures free and polysomnography showed a normalization of the sleep macrostructure.
A 43-year-old man presented with nocturnal stereotyped seizures from the age of 20, characterized by scratch movements, dystonic posturing of the left toe, paroxysmal arousal associated with distressed emotions. The patient also complained daytime sleepiness, daily concentrating troubles and depression state.
The family history was positive for febrile seizures. Ictal videopolysomnography showed bilateral frontal slow waves that arise during the transition phases between NREM and REM sleep. The brain MRI was normal and mutations in nAChR were undetected.
Despite treatment with oxacarbazepine therapy 600 mg/day, nighttime seizures persisted at the frequency of 3-4 per night.
In the past, the patient had not tolerated the CBZ for the onset of balance disorders.
Finally, the oxacarbazepine was slowly stopped and the patient started lacosamide until the dosage of 100 mg BD.
After 6 months of follow-up, the patient was seizures free and after 12 months follow-up the daytime sleepiness and depression state disappeared.
Nocturnal Frontal Lobe Epilepsy (NFLE) is a form of focal nocturnal epilepsy that due to its heterogeneous clinical presentation, the almost absence of EEG abnormalities and the recurrence of episodes during sleep, was renamed Sleep-Related Hyper motor Epilepsy (SHE) .
Although epileptic seizures are non-disabling since they occur at night and are controlled by CBZ, these patients showed a reduced sleep quality that is negatively reflected on the activities of daily life.
The night-time awakenings sleep fragmentation and parasomnias, induce an excessive daytime sleepiness and paradoxical insomnia.
This report has shown how lacosamide can be effective not only in the treatment of nocturnal seizures, but also in sleep disorders associated with them in SHE, probably due to the multiple action mechanisms of this drug (slow inactivation of voltage-gated sodium channels, inhibitions of carbonic anhydrases) .
Although in the literature has recently described some cases of NFE patients successfully treated with lacosamide , further studies will be needed to confirm these data and to investigate the positive effects of the drug on heterogeneous sleep disorders in this category of patients.
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