NREM parasomnias: arousal disorders and differentiation from nocturnal frontal lobe epilepsy
Abstract
Parasomnias emerging from NREM sleep such as sleep walking, sleep terrors and confusional arousals are considered arousal disorders. Nocturnal video-polysomnography is the gold standard to diagnosing and differentiating parasomnias from other arousals with atypical motor behaviors such as nocturnal frontal lobe epilepsy (NFLE). This form of nocturnal seizures with prominent dystonic-dyskinetic components, in some cases genetic, has been recently identified by means of detailed video-analysis of movements during sleep. The clinical picture of parasomnias (with onset in early childhood, rare episodes of long duration, absence of stereotypy, general disappearance after puberty) is different from that of NFLE (which first occurs between the age of 10 and 20, manifests frequent complex and repetitive behaviors of short duration excluding rare prolonged seizures, nocturnal agitation, some daytime complaints such as fatigue or sleepiness, persistence into adulthood). Patients show no difference from classical sleep parameters whilst microstructure analysis shows sleep instability and arousal fluctuations in parasomnias and NFLE. In children as well, at least in our experience, the differential diagnosis between the two disorders is difficult and requires one or more complete nocturnal video-polygraphic recording. In any case the diagnosis of NFLE should be considered in children with nocturnal motor episodes or nocturnal motor agitation, when the attacks persist; this diagnosis is probably more frequent than expected.
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Clinical manifestations of nocturnal frontal lobe epilepsy include vocalization, dystonic posturing, repetitive movements of arms and legs, kicking, pelvic thrusting, and sometimes ambulation.
“Clinical manifestations include vocalization, dystonic posturing, repetitive movements of arms and legs, kicking, pelvic thrusting, and sometimes ambulation (walking or running) [68, 69].”
From Sleep Terrors: An Updated Review (2020) · cites this paper as [69]
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- Authors
- Zucconi, M., & Ferini-Strambi, L.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- Corresponding author
- Zucconi, Marco
- ORCID
- Zucconi, Marco
- Venue
- Clinical Neurophysiology
- Publisher
- Elsevier BV
- Published
- 2000-09
- Volume
- 111
- Pages
- S129-S135
- ISSN
- 1388-2457 (ISSN-L)
- OpenAlex
- W1988801481
- Cited by
- 139
- References
- 50
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 8 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 2 · 2017: 5 · 2016: 7 · 2015: 5 · 2014: 7 · 2013: 9 · 2012: 10
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Neurophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fondazione Telethon (E.C839)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- NREM parasomnias, arousal disorders, nocturnal frontal lobe epilepsy, sleepwalking, sleep terrors, confusional arousals, nocturnal seizures, differential diagnosis, sleep instability
- MeSH terms
- Child, Circadian Rhythm, Humans, Sleep, Epilepsy, Frontal Lobe, Sleep Arousal Disorders, REM Sleep Parasomnias
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