ABSTRACT
A dilemma can arise when attempting to distinguish a nocturnal seizure from a parasomnia because both phenomena can be characterized by a general increase in motor and autonomic activity with a transient reduction in the level of consciousness. An additional problem is that an accurate clinical diagnosis generally relies heavily on a detailed history. As sleep related disorders occur at a time when the patient is not fully cognizant, polysomnographic analysis can on occasion supplement for the intrinsic paucity of detailed history. Simultaneously, correlating the clinical and polysomnographic analysis immediately prior to, during, and following an event of interest, can be helpful in differentiating nocturnal seizures from parasomnias.
Subject(s)
Epilepsy/diagnosis , Parasomnias/diagnosis , Polysomnography , Adult , Aged , Child , Diagnosis, Differential , Electroencephalography/methods , Epilepsy/physiopathology , Female , Humans , Male , Middle Aged , Parasomnias/physiopathology , Signal Processing, Computer-Assisted , Sleep Bruxism/diagnosis , Sleep StagesABSTRACT
We evaluated the utility of accurate clinical and electrophysiologic characterization in the diagnosis of the rhythmic movement disorder. Seven children with an age range of 1-12 years, referred for evaluation of relatively violent nocturnal behaviors, were clinically assessed during split-screen, video-polysomnographic monitoring sessions, as they experienced unusual nocturnus movements. Differential diagnoses included self-injurious waking behaviors, seizures, and parasomnias such as somnambulism (sleepwalking), pavor nocturnus (night terrors), and the rhythmic movement disorder (headbanging, bodyrocking, and legbanging). The character of movements, level of responsiveness, and electrophysiologic stage of sleep was determined during typical spells. In all the subjects experienced 37 periods of headbanging, bodyrocking, and legbanging that were strongly associated with stage 2 non-rapid eye movement sleep and K-complexes. The patients were unresponsive during and amnestic for the events. Because the differential for the rhythmic movement disorder includes a large number of disorders associated with abnormal and at times violent nocturnal movements, diagnosis can be greatly enhanced by documenting suspected nocturnal behaviors with thorough clinical assessment during split-screen, video-polysomnographic analysis.
Subject(s)
Movement Disorders/diagnosis , Polysomnography/instrumentation , Video Recording/instrumentation , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/physiopathology , Cerebral Cortex/physiopathology , Child , Child, Preschool , Diagnosis, Differential , Evoked Potentials/physiology , Female , Humans , Infant , Intellectual Disability/diagnosis , Intellectual Disability/physiopathology , Male , Movement Disorders/physiopathology , Seizures/diagnosis , Seizures/physiopathology , Signal Processing, Computer-Assisted/instrumentation , Sleep, REM/physiology , Stereotyped Behavior/physiologyABSTRACT
OBJECTIVE: To demonstrate the utility of accurate clinical and electroencephalographic characterization of provoked cataplexy spells in the diagnosis of narcolepsy. METHODS: Four individuals, three with suspected and one with known narcolepsy, were clinically assessed during split-screen, video polysomnographic monitoring sessions after cataplectic events were induced by emotional provocation. RESULTS: The subjects experienced a total of nine cataplectic-like events, one occurring spontaneously (sleep paralysis) in association with a hypnagogic hallucination. During all events, the patients appeared to be sleeping with polysomnographic rapid eye movement sleep patterns, but when questioned they were able to give appropriate verbal responses. The diagnosis of narcolepsy was substantiated in all cases using standard overnight polysomnograms and multiple sleep latency tests. CONCLUSION: The diagnosis of narcolepsy can be greatly enhanced by documenting cataplexy with thorough clinical assessment and demonstration of typical rapid eye movement sleep patterns during provoked spells in the course of polysomnographic monitoring sessions.
Subject(s)
Cataplexy/diagnosis , Narcolepsy/diagnosis , Adolescent , Adult , Cataplexy/physiopathology , Electroencephalography , Electromyography , Electrooculography , Electrophysiology/methods , Emotions , Female , Humans , Male , Middle Aged , Narcolepsy/physiopathology , Paralysis , Sleep, REM , Video Recording , WakefulnessABSTRACT
OBJECTIVE: To polysomnographically determine, using split-screen electroencephalographic-video analysis, the cause of violent sleep-related activity in a patient whose differential diagnosis includes sleep walking (somnambulism), pavor incubus (adult night terrors), nocturnal seizures, psychogenic wandering, and rapid eye movement sleep behavior disorder. SETTING: The patient was referred to the University of Iowa, Department of Neurology Sleep Disorders Center, Iowa City, from the local community to evaluate a history of violent dreams associated with injury. The subject presented with a subdural hemorrhage that was discovered with magnetic resonance imaging. OUTCOME: The diagnosis of rapid eye movement sleep behavior disorder was confirmed after a characteristic spell of violent behavior, with an associated dream, was captured polysomnographically.
Subject(s)
Cerebral Hemorrhage/etiology , Dreams , Mental Disorders/complications , Sleep Wake Disorders/complications , Violence , Accidental Falls , Aged , Humans , Male , Polysomnography , Sleep Wake Disorders/physiopathology , Sleep, REMABSTRACT
The clinical diagnosis of narcolepsy often depends on the coexistence of pathologic sleepiness and cataplectic attacks. We present a case of narcolepsy unequivocally diagnosed after daytime, split-screen, video-polysomnographic monitoring captured a prolonged cataplectic event during which the patient was coherent, conversant, and in electroencephalographic rapid eye movement sleep.
Subject(s)
Catalepsy/diagnosis , Narcolepsy/diagnosis , Adult , Catalepsy/complications , Catalepsy/physiopathology , Electroencephalography , Humans , Male , Narcolepsy/complications , Narcolepsy/physiopathology , Polysomnography , Sleep, REM/physiology , Television , Time FactorsABSTRACT
Intermittent catheterization remains the primary method of treatment in the management of patients with neurogenic bladders such as those with meningomyelocele. In a follow-up of a previous study, we re-examined the urologic status of patients with neurogenic bladders continuing on a regimen of clean intermittent catheterization five years after the completion of the first study. Thirty-seven of the original 49 patients were available for follow-up, and no significant differences were found between those lost to follow-up and those included in this study. Among the patients re-evaluated, reflux remained unchanged or improved in most patients, renal function was maintained, and the urinary tract infection rate remained low. Additionally, continuation of an intermittent catheterization program does provide independence and social continence in most young adults with meningomyelocele. We conclude that a long-term intermittent catheterization program is associated with stable reflux status, renal function, and infection rate, and that compliance with a catheterization program can result in improved social continence and independence.
