[Day time fatigue in frontal lobe epilepsy with primarily sleep-related seizures. A case report]

We present a 43-year-old patient who has had up to 15 frontal lobe seizures nightly for 12 years. The patient had no complaints apart from excessive daytime sleepiness. Neurological and psychiatric examination as well as cerebral computed tomograph and magnetic resonance imaging were normal. After sleep deprivation an interictal electroencephalogram demonstrated a recurrent excess of theta activity over the right frontal and frontopolar area. A cerebral PET study showed diminished glucose metabolism of the right cingular and frontomesial region. The sleep structure was extremely fragmented. There was an excessive reduction of slow-wave sleep and REM sleep. Carbamazepine therapy produced complete seizure control lasting a few weeks, followed by return of up to 8 seizures per night. Vigabatrin as add on therapy diminished the noctural seizures to 1 to 3 per night.