Abstracts

Rationale: Different pathological conditions may lead to somnambulic automatisms arising from nocturnal sleep: sleep walking as a disorder of arousal or nocturnal complex partial seizures (nocturnal wandering). It is often hard to pose a correct differential diagnosis between DOA and nocturnal epilepsy because of the similar features of the sleep episodes. Video-polysomnography represents the best diagnostic tool but, due to the difficulty of capturing complex episodes in the sleep laboratory, audio-video recordings of the episodes at home may also prove helpful in determining the differential diagnosis. Methods: Over the last year we evaluated 18 patients referred to our sleep center for deambulatory complex behaviour during sleep. They all underwent clinical interviews, neurological exams, neuroimaging and one night video-PSG with extended EEG. We also suggested the employment of video recordings at home to better capture the nature of the episodes. Results: 9/18 patients (mean age 24 y) were male, 9/18 female (mean age 22 y). All patients referred at least one nocturnal episode characterized by walking, talking, confusion and agitation: these events occurred in the first third of the night in 11 pts, in the second third in 8. The frequency of these episodes varied from 1 a month to every night; some patients even presented multiple episodes per night. The patients that suffered from frequent episodes also presented more stereotypical behaviours. Moreover, all but 6 patients presented minor nocturnal events (rubbing nose and head, hand clapping or pelvic thrusting). Neurological exams were negative in all patients. Neuroimaging (CT or MRI) results were positive for frontal cortical dysplasia in 2 patients. Only 2 patients had a positive family history for disorders of arousal and 2 for epilepsy. Overnight video-PSG with extended EEG demonstrated only minor events; interictal epileptic discharges (IEDs) were found in 12/18 (7 frontal and 5 temporal). Home recorded episodes were similar but more complex compared to lab recordings. 4 patients suffered from migraine, 2 from tyreopathy, 1 from multiple sclerosis and 1 was epileptic since childhood. Sleep was overall fragmented by multiple arousals, even if SWS (N3) was well preserved. A diagnosis of certain or probable epilepsy was reached for 9 patients (6 NFLE and 3 NTLE) whereas a diagnosis of parasomnia, mainly DOA, was given to 9. 4 pts showed overlapping episodes. Antiepileptic drugs (mostly LEV and TPM) were prescribed in 12 patients with over 50% reduction of nocturnal events. Conclusions: It is difficult to reach a specific diagnosis in the presence of abnormal, complex nocturnal behaviours. Video-PSG, ictal features, possible IEDs, age and timing of onset may all result imperative for the final diagnosis.