2020 Volume 69 Issue 1 Pages 106-111
A man, aged 68, was admitted to our hospital because of seizure during sleep. Video polysomnography (PSG) using 10–20 full montage electroencephalography (EEG) and sleep apnea sensors was performed to confirm the diagnosis. PSG revealed an interictal sharp wave in the right frontotemporal lobe and frequent apnea–hypopnea events, which led to the diagnosis of temporal lobe epilepsy and obstructive sleep apnea syndrome (OSAS). Administration of an anti-epileptic drug (AED) and continuous positive airway pressure (CPAP) was started for the treatment. However, after a while, the patient stopped these treatments on his own free will, which resulted in the recurrence of seizures; thus, CPAP was resumed. Then, PSG with CPAP titration was carried out, which demonstrated the reduction in the frequency of obstructive apnea–hypopnea events by CPAP therapy. Nevertheless, central apnea events following EEG epileptiform discharges were observed five times over the night. Because no convulsion was observed on the video at those times, we regarded the events as nonconvulsive epileptic seizures. Epilepsy and OSAS comorbidity is not rare. It is shown by this case that there are two types of sleep disordered breathing in cases with this comorbidity: one type is characterized by events caused by upper airway obstruction and the other type by events following epileptic seizures. The therapies appropriate for these two types are different: CPAP for the former and AED for the latter. To differentiate these two types, the skill to interpret EEG recordings correctly is required.