Nocturnal Seizures Mimic REM Behavior Disorder

Distinction of nocturnal seizures and REM behavior disorder is traditionally based on historical features or stereotypical behaviors, time of night, and ability to recall dream imagery during the episode. We present a patient who had dream enactment that typically occurred between 4:00 and 6:00 a.m. and correlated with a rhythmical electroencephalographic discharge in the frontal region. This case demonstrates that patients who are resistant to therapy for typical symptoms of REM behavior disorder should be evaluated for possible nocturnal seizures.