Ictal central apnea and bradycardia in temporal lobe epilepsy complicated by obstructive sleep apnea syndrome

We describe the case of a 12-year-old boy who developed temporal lobe epilepsy (TLE) with daily complex partial seizures (CPS) and monthly generalized seizures. Moreover, he frequently snored while asleep since early childhood. Polysomnography (PSG) revealed severe obstructive sleep apnea with apnea–hypopnea index (AHI) of 37.8/h. Video-PSG with simultaneous electroencephalography (EEG) recording captured two ictal apneic episodes during sleep, without any motor manifestations. The onset of rhythmic theta activity in the midtemporal area on EEG was preceded by the onset of apnea by several seconds and disappeared soon after cessation of central apnea. One episode was accompanied by ictal bradycardia of < 48 beats/min which persisted for 50 s beyond the end of epileptic activity. After treatment with carbamazepine and tonsillectomy/adenoidectomy, the seizures were well controlled and AHI decreased to 2.5/h. Paroxysmal discharges also disappeared during this time. Uncontrolled TLE complicated by sleep apnea should be evaluated for the presence of ictal central apnea/bradycardia.