• Female, aged 58 with a BMI of 33.9 with a 3 year history of nocturnal behaviours in keeping with sleep walking.
  • Patient will wake to find herself in the wrong end of the bed or in another room in the house. She has no recollection of what occurred through the night. Other evidence that an event has occurred can be that things are moved, curtains open etc.
  • Frequency of events is 1-2 per month
  • No eye witness to events as patient has no bed partner.
  • Patient has a history of nocturnal epileptic seizure since 1978 and is currently on Tegretol, 200mg bd and feels her seizures are under control, although admits she may be unaware of their return.
  • Otherwise, patient does not report day time sleepiness and feels she sleeps well generally, normally getting between 7 and 8 hours per night.
  • Admits to being a heavy snorer.

Patient is admitted to Quarriers Sleep Service for three nights' polysomnography.

On the first night, patient has an electrographic seizure discovered by physiologist. This event is not obvious to night staff as the movements are subtle and appear like an arousal from sleep. On closer inspection, patient appears to pick at electrodes and remove some during the post-ictal phase. Spikes are also seen in the inter-ictal EEG.

Her sleep architecture is relatively normal however she has an AHI (Apnoea, Hypopnoea Index) of 17.2 in keeping with moderate sleep disordered breathing (though not obstructive sleep apnoea syndrome as patient does not report day time sleepiness).

In view of these findings, the patient was switched to video EEG monitoring for a more in-depth look at inter-ictal EEG and with a view to capture more seizures with an extended EEG montage. No further seizures are captured although inter-ictal EEG is confirmed as being abnormal with persistent slowing evident and right temporal spikes prominent in sleep. Using evidence from PSG and EEG it is felt that the data supports a focal epilepsy of right hemisphere origin. Before the patient was discharged, the Nurse Specialist advised them to increase their evening dose of Tegretol to 400mg.

In Conclusion
Patient’s nocturnal behaviours are more likely to be associated with post-ictal automatism as her epilepsy is not under control as she had thought. No need for second admission to have epilepsy study as sleep/EEG assessments done side by side. Treatment for underlying epilepsy was also able to be implemented on-site during admission.