Coexistence of epileptic nocturnal wanderings and an arachnoid cyst.

Abstract

Episodic nocturnal wanderings (ENWs) have rarely been associated with gross abnormalities of brain structures. We describe the case of a patient with ENWs in coexistence with an arachnoid cyst (AC). The patient was a 15-year-old boy who presented with nocturnal attacks characterized by complex motor behaviors. An MRI revealed a left temporal cyst and a SPECT Tc99 scan showed left temporal hypoperfusion and bilateral frontal hyperperfusion, more evident on the right side. During an all-night polysomnographic recording with audiovisual monitoring, dystonic posture followed by sleepwalking-like behavior was documented. The sleepwalking-like behavior was preceded by a spike discharge over the left frontocentral region with contralateral projection and secondary generalization during stage 2 sleep. Treatment with levetiracetam produced a striking remission of seizures. This supports a conservative management of an AC, considering that it may be an incidental finding. In epileptic patients, an AC may not necessarily be related to the location of the seizure focus.

• Authors: Alejandro Jiménez-Genchi, John L Díaz-Galviz, Juan Carlos García-Reyna, Mario U Avila-Ordoñez
• Journal: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine (J Clin Sleep Med) Vol. 3 Issue 4 Pg. 399-401 (Jun 15 2007) ISSN: 1550-9389 [Print] United States
• PMID: 17694730 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticonvulsants
• Levetiracetam
• Valproic Acid
• Piracetam

Topics

• Adolescent
• Anticonvulsants (therapeutic use)
• Arachnoid Cysts (complications, diagnosis, drug therapy)
• Electroencephalography (methods)
• Epilepsy, Frontal Lobe (complications, diagnosis, drug therapy)
• Humans
• Levetiracetam
• Magnetic Resonance Imaging (methods)
• Male
• Piracetam (analogs & derivatives, therapeutic use)
• Polysomnography (methods)
• Somnambulism (complications, drug therapy)
• Temporal Lobe (diagnostic imaging, pathology)
• Tomography, Emission-Computed, Single-Photon (methods)
• Valproic Acid (therapeutic use)