Teaching video neuro‐image: Hypnopompic seizures

A 7-year-old right-handed boy with a history of tuberous sclerosis (TSC1) was admitted to our epilepsy monitoring unit to capture and characterize his seizures. MRI showed subcortical tubers in the bilateral frontal lobes (Figure 1A). Long-term video EEG recorded multiple electroclinical seizures during sleep. During each seizure, he suddenly awoke from sleep following the electrographic onset visible on EEG, then promptly fell back asleep after the electrographic seizure activity ceased (Video 1). No fear aura or other ictal semiology was observed. The ictal EEG onset was characterized by rhythmic spiking or paroxysmal fast activity over the left frontopolar region with some diffusion to the right frontal region followed by medium to low amplitude fast activity over the left frontal region (Video 1; Figure 1B). Interictal EEG demonstrated polyspikes or paroxysmal fast activity over the left frontal and fronto-central regions and generalized triphasic waves maximum over the bi-frontal region (Figure 1C). Hypnopompic seizures are a rare type of seizure in which arousal is the sole behavioral manifestation.1 They can mimic obstructive sleep apnea and Non-Rapid eye movement sleep (NREM) parasomnias such as sleepwalking and sleep terrors. Therefore, accurate differentiation using video EEG is crucial for effective patient management.2 M.R. conceptualized the case report, drafted the manuscript, and prepared the figures and video legend. G.K. contributed to clinical data review, imaging interpretation, and manuscript revision. A.Z. contributed to the literature review, and manuscript revision. O.F. provided critical revisions and supervision. All authors reviewed and approved the final manuscript. The authors thank the patient and family for their participation. No additional contributions require acknowledgment. No specific funding was received for this study. The authors declare no conflicts of interest related to this work. Written informed consent was obtained from the patient's legal guardians for publication of the clinical information and seizure video. All relevant data supporting the findings of this report are included within the manuscript. Additional de-identified clinical information is available from the corresponding author upon reasonable request. Data S1. Educational slide Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Which of the following statement is true for the hypnopompic seizure? Answers may be found in the supporting information