Abstracts

Rationale: Abnormal sleep behavior characterized by talking, fear, screaming, walking, agitation, may pose some problems of differential diagnosis between sleep disorders (parasomnias) and nocturnal complex partial seizures. Some patients may also have an overlap of these disorders. We evaluated all patients referred to our sleep center over the last year for abnormal nocturnal behaviour including full or abortive ambulatory components. Methods: 21 pts (12M, mean age 21, range 3-53)underwent a clinical interview by a neurologist with sleep/epilepsy expertise, neurological exam, neuroimaging and one night video-PSG with extended EEG montage 18 leads (10-20 IS). All patients were also invited to produce some amateur night home videos. Results: All patients reported various degrees of abnormal nocturnal behaviour. On video-PSG all recorded subjects presented minor events (scratching or rubbing the nose and the head or clapping the hand or pelvic thrusting) and 57% had also major attacks (sudden elevation of the head and trunk, screaming, limb agitation) occurring during NREM sleep. In 6 patients, abnormal behaviours were stereotyped, short, repeated several times during the night. Interictal EEG abnormalities (IEDs) were found in 11/21 patients (5 frontal and 6 temporal), 8 of which had major and complex events. A positive familial history was reported for epilepsy and for DOA in 4 patients each. Overall, although of the same type, home recorded episodes were similar but more complex especially in the case of seizures or paroxysmal arousals. Diagnosis of certain or probable epilepsy was given to 8 patients whereas in the remaining patients we concluded for a parasomnia disorder, mostly DOA. Antiepileptic drugs (LEV and TPM) were prescribed in all “epileptic patients” with reduction of nocturnal motor events. Conclusions: It is very difficult to reach a diagnose of certainty in the presence of abnormal and complex motor nocturnal behaviors. Video polysomnography may help the interpretation of clinical features and behaviours by revealing additive factors such as frequency and localization of ictal and interictal discharges, timing of the episodes and sleep structure quality.