Nocturnal epilepsy masquerading as a behavioral problem in childhood

Area of Science:

• Neurology
• Pediatrics
• Sleep Medicine

Background:

• Nocturnal epilepsy, a recognized clinical syndrome since the 1950s, is more frequently documented in European literature.
• It is notably underrepresented in current American pediatric textbooks, leading to potential diagnostic delays.

Observation:

• Two pediatric cases initially presented as behavioral problems, complicating diagnosis.
• Standard physical examinations and waking electroencephalograms (EEG) were unremarkable in these cases.
• Behavioral interventions failed to resolve the presenting issues, prompting further investigation.

Findings:

• Nocturnal epilepsy diagnosis was supported by subsequent evaluation and therapeutic response in the presented cases.
• Key diagnostic clues include specific historical elements and the inefficacy of behavioral management.
• Electroencephalography conducted during sleep proved diagnostic in the majority of patients, unlike waking EEGs.

Implications:

• Highlights the importance of considering nocturnal epilepsy in children with unexplained behavioral symptoms.
• Emphasizes the diagnostic utility of polysomnography (sleep EEG) for nocturnal epilepsy.
• Suggests a need for increased awareness and inclusion of nocturnal epilepsy in pediatric training and literature.