The abnormal, often aggressive behavior during sleep has been understood as one of the symptoms of parasomnias. It has been known that parasomnias appear in relation to a particular sleep stage. Somnambulism (sleepwalking) and night terrors arise spontaneously out of stage 3-4 NREM sleep with abnormal arousal. Although somnambulism and night terrors are considered to be childhood, these parasomnias are by no means rare in adult. The episodes resembling somnambulism and night terrors are observed during REM sleep. The abnormal behavior during REM sleep is so called as REM sleep behavior disorder.
Also nocturnal abnormal behavior is appeared in sleep related epilepsy, especially, nocturnal frontal lobe epilepsy and temporal lobe epilepsy. In the patients with nocturnal abnormal behavior, screaming or unintelligible vocalization, kicking, jump out of window, wandered around room or street, choking wife and throwing his baby outside window have been reported.
The long-term EEG-Video monitoring and polysomnographic recording are useful to investigation in nocturnal abnormal behavior.

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Clobazam (CLB) is the first antiepileptic drug synthesized with a 1,5-benzodiazepine structure and was launched in May 2000. Efficacy and resistance of CLB were retrospectively surveyed in 384 epileptic patients enrolled in several clinical studies.
The survey showed that clinical improvement, defined as reduction in seizure frequency by more than 50%, was observed in 69.0% and 69.5% of the patients at 2 and 12 weeks, respectively, after the start of treatment, suggesting early acting and lasting efficacy of CLB. The efficacy of the drug was further analyzed by stratifying the seizure type into partial seizure and generalized seizure, and the results showed a broad therapeutic spectrum of CLB. Therapeutic resistance was found in 19.5% of patients. However, there was no significant difference in rate of resistance between partial seizures and generalized seizures. CLB did not induce any serious adverse effect but only common mild adverse effects.

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Recent experimental evidence suggested that adenosine has both pre-and post-synaptic anticonvulsive actions; however, there is little information available as to the post-synaptic action. We examined the correlation between the concentration and the post-synaptic anticonvulsive action of adenosine using Mongolian gerbil hippocampal epilepsy model. The recording electrode was placed on CA-1 stratum pyramidale, and CA-1 cells were stimulated antidromically. Afterdischarges (AD) were observed following a population spike, during perfusing low calcium medium. Amplitudes of the first AD (FAD) of CA-1 were recorded before and after perfusing low calcium medium with 0 (n=8), 10 (n=7), 20 (n=10), 40 (n=10) and 80 (n=9) μmol/l adenosine. After perfusing 0, 10, 20, 40, and 80μmol/l, the rate of FAD were reduced significantly until 40μmol/l (143.0±11.4, 111.6±7.0, 80.5±23.9, 56.6±19.8, 52.8±18.9%) respectively) (p<0.05). Adenosine reduces post-synaptically epileptiform activity in a concentration-dependent manner between 0 and 40μmol/l. Adenosine plays an important role as an endogenous epileptic inhibitor, and this approach holds promise as a future therapeutic strategy for epilepsy.

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Cranial navigation techniques assist neurosurgeons in localizing the pathology during operation. These techniques require magnetic resonance imaging for registration before surgery and there has been some difficulty for applying to corticotomy following invasive monitoring. The authors have applied this technique to the resection of seizure foci following invasive monitoring and one representative case of parietal lobe epilepsy was reported. Before implantation of intracranial electrodes, magnetic resonance imaging was obtained with fiducial markers on the scalp. To avoid shift of fiducial markers, these were placed far enough from skin incision and rigidly fixed to the scalp. During resection of seizure foci, resection of epileptogenic cortex was accomplished according to the result of cortical mapping and the guidance of cranial navigation. Potential hazards included brain shift due to cerebrospinal fluid loss and the mass effect of subdural grid electrodes.

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In intractable adult epilepsy, persistent seizures constitute great psychological and economic burdens on the patients and their families. In addition, social independence is greatly restricted due to the loss of employment opportunity as a result of seizures, and such social disability is an important issue. In Japan, the way to solve this social disability has not been adequately paved. In this report, two cases were presented.
The first case was a patient with temporal lobe epilepsy having an epileptogenic focus on the medial side of the right temporal lobe. She underwent the standard anterior temporal lobectomy at 22 years of age, 21 years after the onset of seizures. With complete remission of seizures after the surgery, employment became possible. She has remained seizure-free to date, 4.5 years after the surgery. The second case was a female patient with mild intellectual disability, whose seizures also were refractory to medical therapy and have continued to date. This patient was admitted to a vocational training institute for the psychiatric patients, which has allowed her to participate in the society. For patients with intractable adult epilepsy, considerations should be given to accurately evaluate the limitation of antiepileptic drug treatment, and adopt surgical treatment actively for indicated cases. For pateints who are not surgical candidates, admission to institutions and other social resources should be utilized aiming to allow these patients to gain social independence.

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