Nocturnal motor events in epilepsy: Is there a defined physiological network?

Paroxysmal nocturnal movements in epilepsy are a recognised phenomenon, however, the mechanisms that produce them and the effect of the underlying epilepsy still remains elusive. In this study, 10 patients were studied to define the cerebral networks corresponding to these movements and explore how epileptiform activity modulated them. We compared the change in power of the 25-250 Hz frequency band using event-related synchronization of all stereo-EEG electrodes implanted, during a baseline segment, during nocturnal movements and seizures. The underlying network activated during these paroxysmal movements comprised the insula, anterior cingulate, premotor areas and orbitofrontal regions. Three groups emerged, (1) complete overlap, (2) no overlap and (3) partial overlap of ERS changes of the epileptogenic zone within the proposed network and correlation of semiology between nocturnal movements and seizures. We conclude that nocturnal movements are due to a complex interplay within this physiological network of defined anatomical regions. Epileptic activity had significant impact on nocturnal movements but was not required for generation. Where the semiology of the first clinical sign of a seizure consistently matches a patient's nocturnal movements, we suggest that the underlying epileptogenic zone is potentially located within this defined network.

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