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We would like to comment on the work by Derry et al1 on distinguishing sleep disorders from nocturnal frontal lobe epilepsy (NFLE). The authors constructed a scale based on specific clinical questions to distinguish a sleep disorder from NFLE. It is certainly possible to reach a diagnosis based in the clinical history alone. However, we want to comment on some aspects of the scale. For example, 1 of the questions uses a cut-off age at onset of younger than 55 years. The onset of symptoms in patients older than 55 years may suggest rapid eye movement (REM) sleep behavior disorder (RBD), according to the authors. However, individuals who are taking selective serotonin reuptake inhibitors may have increased tone during REM sleep and be susceptible to RBD.2 These patients may be younger than those with idiopathic RBD but will be misclassified using the scale.
We also point out that the authors do not mention that about 34% of patients with NFLE may have a personal history that suggests parasomnia.3 Parasomnia may coexist with epilepsy, and it is important to make the distinction between the 2 conditions.4 It is also important to note that 20 patients classified as having “typical parasomnia” did not undergo video electroencephalography–polysomnography. Some of these subjects may have been misclassified.
Another issue is that of recall. Seventy-two percent of the patients with NFLE are not aware of their nocturnal motor manifestations according to 1 study, and the timing and duration of the events may be difficult to determine.3 The authors suggest that epilepsy or sleep training may not be required to reliably make a correct diagnosis. We think that the scale alone is a good screening tool, but it should be accompanied with adequate clinical judgment that comes with experience and training.
Correspondence: Dr Rodriguez, New York University Comprehensive Epilepsy Center, New York Sleep Institute, 724 Second Ave, New York, NY 10016 (alcibiades.rodriguez@med.nyu.edu).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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