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Choking Fits During Sleep Related to Epilepsy

      We report the case of a 42-year-old man who, during adolescence, developed brief nocturnal episodes of a feeling of choking. He was awakened with a feeling of being unable to get his breath, without any other symptoms and with preserved consciousness. He suffered from up to 30 episodes per night, each lasting 15-20 seconds. Interictal electroencephalogram (EEG) was normal. Video-EEG recorded episodes during non-rapid eye movement (non-REM) sleep without any clear epileptiform discharge but the stereotyped episodes led to a diagnosis of epilepsy. Cerebral magnetic resonance imaging was normal. Seizures ceased with phenytoin and phenobarbital treatment. His brother suffered from similar seizures, from the age of 10 years. Phenobarbital and benzodiazepine allowed the suppression of seizures. Ictal EEG showed bifrontal high-voltage polyspike discharges during non-REM sleep. His father suffered from identical episodes starting at age 56 years. His episodes were rare (one every 6 months, except for one cluster of several episodes on one occasion). He was awakened by a feeling that “his lungs were inflated with air and (he) could not empty them.” Sleep apnea was excluded by polysomnography. The son of the index case suffered from a severe, drug-resistant, “nocturnal frontal lobe epilepsy” since the age of 5 years.
      • Ryvlin P.
      • Minotti L.
      • Demarquay G.
      • et al.
      Nocturnal hypermotor seizures, suggesting frontal lobe epilepsy, can originate in the insula.
      The seizures (up to 30/night) consisted in awakening and agitation including swinging, folding arms, and abrupt dystonic movements of the trunk and limbs, lasting <1 minute. Consciousness was preserved during seizures. They started by a feeling of choking, and after the age of 10 years, by a tingling in the back. A change in respiratory rate was also observed on video recordings. He never had a tonic-clonic generalized seizure. Seizures were resistant to many antiepileptic drugs. Interictal EEGs were normal. Ictal EEG showed a diffuse flattening and high amplitude-bi-frontal 12-Hz rhythm during non-REM sleep. Cerebral magnetic resonance imaging was normal.
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