In section 2, we review the important clinical and electrographic features that allow accurate differentiation of these disorders from epilepsy, with particular reference to NFLE. In section 1, we examine the range of nonepileptic disorders that initially may be seen with paroxysmal motor events during sleep and their distinguishing clinical and electrographic features. A full appreciation of this spectrum, and the characteristic features of these conditions, is therefore essential to allow confident diagnosis and appropriate management in this situation. However, the spectrum of motor disorders of sleep is wide, and a diagnostic uncertainty may arise in a number of situations depending on the referral base of the clinician involved. In general, the most common source of diagnostic confusion is between NFLE and the NREM arousal parasomnias. However, many nonepileptic sleep disorders also are characterized by paroxysmal motor activity, and differentiating these conditions from epilepsy (and from NFLE in particular) can be problematic ( Scheffer et al., 1994 Zucconi and Ferini-Strambi, 2000b). These seizures have a tendency to occur during non–rapid eye movement (NREM) sleep, and in nocturnal frontal lobe epilepsy (NFLE) they are restricted to sleep. In particular, frontal lobe seizures, which display a wide range of frequently bizarre clinical features combined with often normal or nonspecific interictal and ictal EEG findings, can be a source of diagnostic confusion. Whereas many nocturnal seizures are easily recognized from the clinical history, some may be more difficult to identify. The diagnosis of paroxysmal events in sleep represents a significant challenge for the clinician, and the differentiation of epileptic seizures from nonepileptic sleep disorders is often a cause for concern.
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