Hypnogenic paroxysmal dystonia: epilepsy or sleep disorder? A case report

A patient was studied who every night experienced several attacks characterized by loud screaming, violent movements of limbs and trunk, and a tonic phase. No epileptiform activity was noted preceding or following these attacks. Prolonged EEG and videotape recordings before and after sleep deprivation, along with neuropsychological and pharmacological data, support the hypothesis of a seizure disorder involving the left temporal region. Nocturnal attacks completely disappeared with carbamazepine. This therapeutic effect was still present after six months of treatment. Sleep organization was also greatly influenced by this medication. The most striking change was the marked and sustained increase of stages 3 and 4 NREM sleep after treatment.