Sleep-related screaming as a manifestation of frontal lobe epilepsy in a 8 year-old girl: Case report with diagnostic polysomnographic and neuroradiological findings

We report the case of a 8-year-old girl with a 3-month history of sleep-related screaming during both the night and daytime naps. A terrified expression accompanied the episodes of screaming, often with dream mentation and clouded consciousness. Her parents witnessed up to 5-6 episodes every night, with each episode lasting for less than 1 minute. A polysomnographic study documented six episodes of paroxysmal screaming without limb movement, with all episodes emerging from stage 2 non-REM sleep, and episode duration usually lasting 30-60 seconds. Suppression of the generalized background EEG activity occurred for 5-10 seconds before the onset of epileptiform activities (a run of sharp waves) and the onset of screaming. Brain MRJ revealed right orbitofrontal lobe cortical dysplasia. Therapy with oxcarbazepine, 300 mg at bedtime, fully suppressed the sleep-related events, with a prompt relapse whenever the medication was not taken. Daytime wakeful seizures eventually appeared, and the girl had a seizure attack characterized by generalized choreiform and dystonic movements lasting for less than one minute, without any postictal confusion. Her consciousness was fully preserved during the attack. This patient had typical and atypical features of frontal lobe epilepsy.