Although respiration difficulties are not uncommon during epileptic activity, seizures with apnea only are quite rare in adults. A 20-year-old man visited our sleep center because of snoring and sleep apnoea; the symptoms had started two years prior.
The next night, a 16-channel video-EEG monitoring was performed to classify these events and to determine the temporal relationship of apnea onset and Ictal discharge. To our knowledge, this is the first adequately documented case report of pure epileptic seizures presenting with obstructive type sleep apnea as initial symptom.
On the basis of the polysomnography, EEG, and SPECT findings, a rare form of nocturnal frontal lobe epilepsy (NFLE) was strongly considered. The nerve supplies to the respiratory muscles and the larynx, both sensory and motor, occur through the vagus nerve via the superior and inferior laryngeal nerve branches. Polysomnography, EEG, and imaging in a case of epileptic seizures presenting as obstructive sleep apnea.
We report a case of a patient with seizures who presented with obstructive sleep apnoea; the seizures were documented by continuous EEG and polysomnography as well as ictal single photon emission computed tomography (SPECT). He worked for the military, and his apnea and snoring were bothering colleagues in the barracks. Ten apneic events with ictal discharges preceding the apnoea were recorded throughout the night. We repeatedly documented that the ictal discharges clearly preceded the sleep apnea episodes. Contrary to typical apnea, however, rhythmic epileptiform discharges appeared at bifrontal area on EEG just before the start of apnoea.

His daily life was normal, and he had neither a family history nor a medical history of seizures and had previously been healthy.
Ictal EEG showed paroxysmal rhythmic discharges in the range of 9 to 10Hz in the bifrontal area starting just before onset of the apneic episodes. Respiratory arrest as part of a seizure pattern was first described by Jackson.1 Apneic seizures are known to be very rare in adults. However, this case demonstrates that NFLE can also present with choking episodes that are initially attributed to obstructive type sleep apnea.
Therefore, the primary treatment for obstructive sleep apnea focuses on maintaining the patency of the airway. Nocturnal frontal lobe epilepsy A clinical and polygraphic overview of 100 consecutive cases.
Video-EEG monitoring was performed to classify these events, and to evaluate the relationship of apnoea and ictal discharge. His Epworth Sleepiness Scale (ESS) score was 14 out of 24, which suggested moderate excessive daytime sleepiness.
Apnea during a seizure may be due to muscle contraction of the respiratory muscles or reduced central breathing drive (central apnea).
Epilepsy has various clinical presentations, and it should be included in the differential diagnosis of apnea. Most of the case reports regarding apneic seizures are of the central apnoea type.2,3 However, in this case, the apnoea was of the obstructive type, which may have been caused by tonic contraction of the respiratory muscles. For these reasons, it is crucial to obtain ictal confirmation showing EEG discharges preceding apneic events.

One second later, the chin EMG increased and the apnea began with paradoxical wall movement (arrow), indicating an obstructive type apnea. These apneic episodes consisted of respiratory cessation accompanied by chest and abdominal movements of the obstructive type. Given these findings, we concluded that these events were epileptic seizures presenting as obstructive sleep apnoea. A firm diagnosis is extremely important because without it one may treat with conventional obstructive sleep apnea therapy. Given these findings, we concluded that these events were epileptic seizures presenting as obstructive sleep apnea.
Oldani reported two patients who showed obstructive apnea during seizures in the night.4 But the apneas were not the typical initial symptoms in those cases.
Seven out of nine apneic episodes were accompanied by rhythmic paroxysmal discharges in the bifrontal areas on EEG; clinically, five of the episodes progressed to tonic movement of all four limbs, and two episodes showed apneas only. This case demonstrates that nocturnal frontal love epilepsy may be the potential cause of obstructive sleep apnea (OSA). All that seven episodes occurred during NREM sleep (two in stage 1, four in stage 2, and the others in stage 3). Our patient is unique in that the apnoea is the first semiologic symptom, the ictal discharges started in the bifrontal areas during all recorded episodes, and the ictal SPECT revealed an abnormality in the right frontal area.

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Comments Seizures and obstructive sleep apnea

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  3. spaider_man
    Subsequently comparable studies have been carried can quite typically outcome in snoring.