Diagnostic Evaluation
For many patients, the history is sufficient to diagnose an arousal disorder no laboratory studies are required. For example, typical episodes of sleepwalking or sleep terror that occur in children or young adults generally do not require additional evaluation. Diagnostic studies are more often needed if the history has atypical features, such as stereotyped behaviors, frequent occurrence in the second half of the night, or onset during adulthood. Definitive diagnosis with laboratory studies...
Cyclic Alternating Pattern And Noncyclic Alternating Pattern
CAP is organized in sequences of two or more CAP cycles. Each CAP cycle consists of a phase A and a phase B, each lasting between 2 and 60 s. All CAP sequences begin with a phase A and end with a phase B. In NREM sleep, the phase A patterns are composed of the single or clustered arousal-related phasic events peculiar to the single sleep stages Intermittent alpha rhythms and sequences of vertex sharp waves, in stage 1 Sequences of two or more K-complexes with or without alphalike components and...
Hypogenic Paroxysmal Dystonia Or Epilepsy
Lugaresi and Cirignotta 1981 described five patients with recurrent nocturnal episodes of agitation during nonrapid eye movement NREM sleep, consisting of violent limb movements and tonic spasms of 15-45-s duration with preserved consciousness, responsive to carbamazepine. Impressed by the resemblance of these clinical manifestations to the attacks of paroxysmal kine-sigenic choreoathetosis and the absence of epileptiform EEG changes, they coined the term hypnogenic paroxysmal dystonia....
Nocturnal Dissociative Disorder
In dissociative disorder, the major symptom is a disruption of consciousness, identity, memory, or perception that has a psychogenic basis. If the disturbance affects consciousness primarily, awareness is dissociated from behavior and patients engage in complex behaviors for which they are amnestic. Identity is primarily affected in depersonalization disorder and multiple personality disorder American Psychiatric Association, 1994 . While prolonged nocturnal fugues occur in some patients, brief...
Rhythmic Movement Disorder
Rhythmic movement disorder, characterized by stereotyped repetitive movements of the head and neck, or sometimes the trunk, is also called head-banging, head-rolling, body-rocking, or body-rolling depending on the type of movement. Other terms sometimes employed include jactatio capitis nocturna and rhythmie du sommeil. The movements occur during drowsy wakefulness and stage 1 sleep at a rate of 0.5-2 Hz, rarely during deeper stages of NREM or REM sleep, and may last from a few seconds to as...
Parasomnia Overlap Disorder
Our center has reported on a group of 33 RBD patients with PSG-docu-mented overlapping NREM-REM sleep motor parasomnias consisting of sleepwalking, sleep terrors, and RBD Schenck et al., 1997b . Mean age was 34 14 years mean age of parasomnia onset was 15 16 years range 1-66 70 n 23 were males. An idiopathic subgroup n 22 had a significantly earlier mean age of parasomnia onset 9 7 years than a symptomatic subgroup n 11 27 23 years whose parasomnia began with neurological disorders, n 6...
Nonepileptic Behaviors During Sleep
Nonepileptic disorders during sleep can be mistaken for epilepsy Herrmann et al., 1993 Scher and Vigevano, 1997 Fusco et al., 1999 . Three groups of patients with which potential diagnostic errors can be made have been discussed. First, LAN N. 6 mths SVP 68 111 100pV _ FIGURE 7.8A Example of infantile spasms at 5 months of age, showing an interictal recording with atypical hypsarrhythmia, with continuous and asynchronous spike and wave activity during the waking state. From Dulac, O., et al.,...
Info Avj
PHT, phenytoin PB, ph nobarbital CBZ, carbamazepine VPA, valproic acid CZP, clonazepam ESM, ethosuximide GBP, gabapentin. I , Decrease f , Increase NC, no change SL, sleep latency AW AR, awakenings arousal WASO, wake time after sleep onset SI, stage 1 S2, stage 2 SWS, slow-wave sleep. PHT, phenytoin PB, ph nobarbital CBZ, carbamazepine VPA, valproic acid CZP, clonazepam ESM, ethosuximide GBP, gabapentin. I , Decrease f , Increase NC, no change SL, sleep latency AW AR, awakenings arousal WASO,...
Pharmacological Manipulations In Cataplexy
Several compounds have been administered intravenously i.v. during H-reflex studies and during long-term investigation of cataplexy in humans more sophisticated studies have been performed using animal models, particularly narcoleptic-cataplectic Dobermans Delashaw et al., 1979 Foutz et al., 1981 Mignot et al., 1988 . The effects of REM sleep-modulating agents and tricyclic antidepressant compounds have been investigated. Compounds with norepinephrine and serotonin reuptake-blocking properties...
Postictal Sleep
Postictal sleep is a common phenomenon after a generalized tonic-clonic seizure. The patient may pass through several stages from sleep to delirium to drowsiness before awakening. During the late postictal state, the heart rate begins to normalize from the typical ictal tachycardia. There is a decrease in muscle tone with bladder sphincter relaxation and incontinence that typically occurs in the early postictal phase. In the immediate postictal phase, there is partial obstruction of the airway...
Electrooculography
The electrooculogram EOG is the second parameter necessary for differentiating sleep stages, and at least two channels are the recommendation. Electrodes can be placed 1 cm lateral to and above one outer canthus, while a second is placed 1 cm lateral to and below the contralateral outer canthus. By referencing these electrodes either to one or to both ear or mastoid electrodes Al, MN1 , horizontal, vertical, and oblique eye movements can all be recorded. If the need arises to distinguish...
Benign Focal Epilepsy Of Childhood 1
The syndrome of benign focal epilepsy of childhood, also referred to as benign rolandic epilepsy or benign childhood epilepsy with centrotemporal spikes, is a common form of childhood epilepsy. The children are of normal intelligence, have a normal neurological examination, and present with sleep-related seizures. Approximately 75 of the seizures occur during sleep Lerman and Kivity, 1975 Loiseau et al, 1973 . The seizures are focal motor usually involving the face and arm , present with...
Association Of Rapid Eye Movement Sleep Behavior Disorder With Specific Human
Narcolepsy, like RBD, is a prominent disorder of REM sleep dysregulation. Narcolepsy has a very strong association with HLA class II genes, with the DQB 1 0602 DQwl group allele being expressed in nearly all cases. Our center performed HLA class II antigen phenotyping in a group of 25 Caucasian males who had RBD but not narcolepsy 84 n 21 were DQwl DQB 1 05,06 positive and 28 n 7 were DR2 positive DQB 1 0501 n 9 and DQB 1 0602 n 7 were the most common phenotypes Schenck et al., 1996b . The 84...
Effects Of Seizures On Sleep And Vigilance
Seizures occurring both at night and during the day can affect sleep architecture and produce daytime sleepiness. In a study comparing the effects of generalized and focal seizures on sleep, nocturnal generalized seizures produced a decrease in sleep time and reduced REM sleep percentage, prolongation of REM latency, and more sleep fragmentation Touchon et al., 1991 . Stages 1 and 2 sleep were increased while the percentage of slow-wave sleep SWS was unchanged. REM rebound an increase in REM...
Mario Giovanni Terzano
Sleep Disorders Center Department of Neurology University of Parma Italy Epilepsy and Vigilance States Sleep Propensity and Body Temperature Rhythms Sleep Intensity and Slow-Wave Sleep Nonrapid Eye Movement Rapid Eye Movement Sleep Cycle Dynamics of Thalamic Neurons during Sleep Low-Frequency lt 1 Hz Oscillations in the Human Sleep Electroencephalogram Cyclic Alternating Pattern as a Marker of Sleep Instability Scoring of Cyclic Alternating Pattern Parameters Cyclic Alternating Pattern and...
Cyclic Alternating Pattern Rate
CAP time is the temporal sum of all CAP sequences. CAP time can be calculated throughout total NREM sleep and within the single NREM stages. The percentage ratio of CAP time to sleep time is referred to as CAP rate. CAP rate can be measured in NREM sleep percentage ratio of total CAP time to total NREM sleep time and in the single NREM stages percentage ratio of CAP time in a given stage to the total duration of that stage throughout sleep . In human sleep, CAP rate is an index of arousal...