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NEUROLOGY 1997;49:969-975
© 1997 American Academy of Neurology

Autosomal dominant nocturnal frontal lobe epilepsy: Demonstration of focal frontal onset and intrafamilial variation

M. Hayman, MB, BS, FRACP, I. E. Scheffer, MB, BS, FRACP, Y. Chinvarun, MD, S. U. Berlangieri, MB, BS, FRACP and S. F. Berkovic, MD, FRACP

From the Departments of Neurology (Drs. Hayman, Scheffer, Chinvarun, and Berkovic) and Nuclear Medicine (Dr. Berlangieri), Austin and Repatriation Medical Centre, Heidelberg (Melbourne), Victoria, Australia; the Department of Neurology (Drs. Hayman, Scheffer, and Berkovic), Royal Children's Hospital, Melbourne, Australia; the Department of Neurology (Drs. Hayman and Scheffer), Monash Medical Centre, Melbourne, Australia; and the Department of Medicine(Neurology) (Drs. Scheffer and Berkovic), University of Melbourne, Australia.

Address correspondence and reprint requests to Dr. Samuel F. Berkovic, Department of Neurology, Austin and Repatriation Medical Centre, Heidelberg(Melbourne), Victoria 3084, Australia.

Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a newly recognized autosomal dominant partial epilepsy. We studied seizure localization and intrafamilial variation using video-EEG monitoring (VEM) and functional neuroimaging in two pairs of subjects from unrelated families. The clinical features of seizures were similar from seizure to seizure in each individual, but varied between individuals. As is often found in frontal lobe epilepsies, ictal EEG localization was imprecise in three of four cases. One patient showed a consistent left fronto-polar onset that was corroborated by congruent focal hypometabolism on interictal PET and focal hyperperfusion on ictal single photon emission computed tomography (SPECT). A second case studied with ictal SPECT showed a right parasagittal, midfrontal focus. We conclude that this autosomal dominant epilepsy syndrome, which in one of the two families was due to a known neuronal nicotinic acetylcholine receptor mutation, causes frontal lobe foci that are unilateral and in variable locations in different individuals.


Supported by the National Health and Medical Research Council of Australia and the Royal Children's Hospital Medical Research Foundation.

Received January 23, 1997. Accepted in final form May 13, 1997.




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