Sleep-isolated trichotillomania as an ictal symptom of complex partial seizure in a 12-year-old girl: a case report

Sleep-isolated trichotillomania (TTM) is the unconscious and automatic pulling of one's hair only while sleeping. In previous case reports, sleep-isolated TTM has been categorized as a sleep-related disorder or a sleep-related dissociative disorder in case reports, and a treatment strategy in this direction has been implemented. However, to our knowledge, no reports have been published describing hair pulling during sleep as a symptom of epilepsy and its pharmacological treatment. In this case report, we present the hair-pulling behavior during sleep as an ictal manifestation of complex partial seizure in a 12-year-old girl and its successful treatment with levetiracetam. We suggest that epilepsy should be suspected in addition to parasomnias and sleep-related dissociative disorder in the differential diagnosis, especially in cases presenting with isolated TTM behavior during sleep.