寝言とみなされていた発作時発話の1例

Ictal Speech Manifesting as Sleep Talking: A Case Report

症例は28歳女性。てんかん発症は19歳。頭部MRIで右傍シルヴィウス裂に多小脳回を認めた。発作症状は，体性感覚前兆，意識減損発作，健忘発作など多彩であった。家族より，寝言が多い翌日は発作が増加する，との病歴が聴取された。長時間ビデオ脳波モニタリングにより「寝言」は右半球性起始のてんかん発作と判明した。医療者は「寝言」が発作症状である可能性を念頭に置き，積極的に病的な「寝言」の存在を聴取する必要がある。

Abstract

We present a 28-year-old female patient whose epilepsy started at the age of 19. MRI showed right perisylvian polymicrogyria. She exhibited various seizure symptoms, such as somatosensory aura involving the left leg, dyscognitive seizures, and amnesic seizures. Her mother indicated that the patient sometimes had “sleep talking”, which was associated with presence of epileptic seizures of the next day. Long-term video electroencephalography (EEG) revealed that her episodes of “sleep talking” were epileptic events, specifically ictal speech, originating in the right hemisphere. The present case demonstrates the importance of considering “sleep talk” as an epileptic symptom. Careful history taking is fundamental to carry patients with possibly pathological “sleep talk” to the long-term video EEG, which will contribute correct diagnosis and treatment.

(Received August 16, 2016; Accepted September 9, 2016; Published February 1, 2017)