Abstracts

Rationale: Nocturnal paroxysmal events occurring in a pediatric population include sleep related movement disorders (SRMD), epileptic seizures, disorders of arousals (DOA), panic attacks and pseudoseizures. The site of primary referral may represent an a priori diagnostic bias toward a sleep disorder rather than epilepsy which could be eventually diagnosed almost unexpectedly. We therefore decided to ascertain which percentage of seizure disorders and which type would be diagnosed by all night video polysomnography after such referral as well as their comorbidity with sleep disorders.Methods: In this study we considered 24 children/adolescents (16M, 8 F, mean age: 10.5, age range: 5-19) referred over the last 18 months for differential diagnosis of nocturnal paroxysmal events not clearly identifiable on the basis of personal or parents’ accounts. We a priori excluded all children with known daytime ictal events of any kind as well as those whose nocturnal events were likely due to arousals from known sleep disorders such as Restless Legs Syndrome (RLS) or sleep related breathing disorders (SDB). Children, in the presence of their parents, underwent a diagnostic interview, a clinical exam and a minimum of one night standard video polysomnography with EEG (10-20 system) full montage. Results: Ictal events similar to those reported on referral were recorded in 15/24 children. EEG recordings were negative in 16 subjects while ictal EEG was positive in 3 children and interictal EEG in 8. Final diagnosis, including patients where no ictal events were recorded, was subdivided according to the following categories: seizure disorders in 4 (1 GTCS, 3 hypermotor seizures, including paroxysmal arousals) DOA in 12, SRMD in 16 (often co-morbid with DOA and/or seizures) and 2 pseudoseizures. Ictal events were easily and successfully controlled by monotheraphy (LEV or TPM). Conclusions: 1/6 of nocturnal paroxysmal events referred to our sleep center proved to be nocturnal seizures easily controlled by monotherapy. DOA and SRMD may co-occur with seizure disorders and challange a correct diagnosis. Interictal night time EEG abnormalities are frequent but not necessarily related to a seizure disorder. No sources of funding.