However, despite thorough evaluation diagnostic confusion may persist. Further evaluation with polysomnogram (PSG) and electroencephalogram (EEG) may help diagnostic confirmation. To avoid diagnostic confusion detailed history is mandatory, often times there are no recollection of the event, or information from witnesses are only limited. Unfortunately, nocturnal paroxysmal motor activity with unusual presentation is not uncommon in clinical practice, and there have been misdiagnosis which have delayed proper treatment.
Among epilepsy, the nocturnal frontal lobe epilepsy (NFLE) commonly presents exclusively during sleep. Epileptic seizure may occur primarily in sleep or upon arousals. The International Classification of Sleep Disorders, 3rd edition (ICSD-3), have broadly classified nocturnal events into parasomnia, sleep related movement disorders, and sleep related breathing disorders. There are various sleep disorders with motor activity during sleep, which may mimic epilepsy. The paroxysmal event during sleep can be a diagnostic challenge as to whether it represents epileptic seizures or non-epileptic sleep disorders.
