Abstract:

Sleep-related hypermotor epilepsy (SHE), previously termed nocturnal frontal lobe epilepsy (NFLE), is a focal epilepsy syndrome characterized by hypermotor seizures or asymmetric tonic/dystonic posturing occurring predominantly during sleep. SHE has heterogeneous etiologies, including genetic factors, structural brain lesions, and unknown causes. Although seizures in SHE commonly originate from the frontal lobe, extrafrontal seizure onset zones—such as the insular, temporal, or parietal regions—have also been identified. Clinically, diagnosis largely depends on detailed seizure history and typical ictal video-EEG recordings. However, scalp EEG often fails to provide specific findings due to movement artifacts or deeply localized seizure foci, presenting considerable diagnostic challenges. In terms of treatment, carbamazepine remains the first-line medication, but alternative drugs such as oxcarbazepine, topiramate, lacosamide, and perampanel offer additional therapeutic options. Advances in our understanding of nicotinic acetylcholine receptor (nAChR) involvement in SHE pathogenesis have prompted exploration of receptor-modulating treatments, such as nicotine patches and fenofibrate, though robust clinical evidence remains limited. For patients with drug-resistant SHE and clearly defined focal structural lesions, epilepsy surgery is an effective option, often leading to excellent seizure outcomes. Despite recent progress in diagnosis and management, substantial gaps and challenges persist in the understanding and treatment of SHE, underscoring the need for further research to improve patient outcomes and quality of life.

Key words: sleep-related hypermotor epilepsy(SHE), nocturnal frontal lobe epilepsy(NFLE), hypermotor seizure, antiseizure medication, epilepsy surgery