SLEEP-RELATED HYPERMOTOR (HYPERKINETIC) EPILEPSY (SHE)

Overview
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Seizure Classification
Generalized onset seizure
- Motor Onset
- Non-Motor Onset
Focal Onset Seizure
- By Onset Feature
- Focal to Bilateral Tonic-Clonic
- Hemispheric lateralization
- Lobar localization
  - Frontal
  - Temporal
  - Parietal
  - Occipital
Unknown Onset Seizure
Neonatal Seizure
Epilepsy Classification
Generalized Epilepsy
Focal Epilepsy
Generalized and Focal Epilepsy
Unknown Epilepsy
Epilepsy Syndromes
Neonate/Infant
- Self-limited
- With developmental and epileptic encephalopathy
Childhood
- Self-limited focal epilepsy syndromes
  - Remission expected in all cases by adolescence
    - Self-limited epilepsy with centrotemporal spikes
    - Self-limited epilepsy with autonomic seizures
  - Remission expected in most cases by adolescence
    - Childhood occipital visual epilepsy
    - Photosensitive occipital lobe epilepsy
- Genetic generalised epilepsy syndromes
  - Epilepsy with eyelid myoclonia
  - Epilepsy with myoclonic absence
- Idiopathic generalised epilepsy syndrome
  - Childhood absence epilepsy
- With developmental and/or epileptic encephalopathy
Variable Age
- Idiopathic generalised epilepsy syndromes
- Focal epilepsy syndromes
- Combined generalised and focal epilepsy syndrome
  - Epilepsy with reading-induced seizures
- With developmental and/or epileptic encephalopathy or progressive neurological deterioration
  - Progressive myoclonus epilepsies
  - Rasmussen syndrome
Epilepsy Etiologies
Genetic Etiologies
- Chromosomal abnormalities
- Gene abnormalities
Structural Etiologies
- Malformations of cortical development
- Vascular malformations
- Hippocampal sclerosis
- Hypoxic-Ischemic
- Traumatic brain injury
- Tumors
- Porencephalic Cyst
Metabolic Etiologies
Immune Etiologies
Infectious Etiologies
Encephalopathy
Epilepsy imitators

SLEEP-RELATED HYPERMOTOR (HYPERKINETIC) EPILEPSY (SHE)

Mandatory seizures

Brief, sleep-related focal motor seizures occur, with vigorous hyperkinetic or asymmetric tonic/dystonic features. These may be accompanied by autonomic features (tachycardia, tachypnea, irregular respiration), vocalization, and negative emotional expression such as fear. Hyperkinetic features involve proximal limb or axial muscles, producing irregular large amplitude movements, such as pedaling, pelvic thrusting, jumping, thrashing, or rocking movements. Seizures may be subtle clinically (previously termed "paroxysmal arousals") or may have longer duration and greater complexity (termed "epileptic wandering"). Patients may describe a focal aware sensory or cognitive seizure before the motor features occur.

May have

Seizures from the awake state

Focal to bilateral tonic-clonic seizures

CAUTION Seizures predominantly from the awake state right arrow consider other epilepsy syndromes.