Meds and sleepwalking

Re: Meds and sleepwalking

Submitted by angel_lts on Wed, 2006-09-06 - 13:38

Glad to hear your daughter is seizure free. I thought you would be interested in this article. take care Lisa http://health.groups.yahoo.com/group/epilepsyapproach/ The Sleep/Epilepsy Correlation, Part II By Alcibiades Rodriguez, M.D. NREM parasomnias Paroxysmal nocturnal events include epileptic and non-epileptic behaviors. Parasomnias are undesirable physical events or experiences that occur during entry to sleep, within sleep and during arousals from sleep. The word derives from the Greek prefix para, meaning alongside of, combined with the Latin somnus for sleep. Parasomnias are divided into Non-Rapid Eye Movement (NREM) parasomnias (confusional arousals, night terrors and sleepwalking), Rapid Eye Movement (REM) parasomnias (REM sleep behavior disorder, recurrent sleep paralysis and nightmare disorder) and non-state dependent parasomnias (rhythmic movement disorder, bruxism and enuresis). NREM parasomnias occur more frequently during the first third of the night (NREM sleep is more common during this time). During this period, the patient is unresponsive to external stimuli and may be confused if awakened. Sleepwalking involves complex, coordinated motor behaviors, including standing and walking. Sleep terrors are characterized by autonomic, motor and vocal manifestations of intense fear. Confusional arousals involve disorientation without the complex motor behaviors of sleepwalking or the intense fear of sleep terrors. These Parasomnias may be very difficult to distinguish from nocturnal seizures, therefore video EEGPolysomnography is required at times (see table 1). Parasomnias are of genetic origin. As a general rule, NREM parasomnias are more common during childhood. However, up to 20% of children who sleepwalk may continue to do so during adult years. NREM parasomnias are exacerbated by sleep deprivation, unusual sleep-wake cycles, some short acting sedatives, stress, anxiety, or any sleep disturbance that affects sleep quality or quantity. These disorders may co-exist with epilepsy in the same patient. If this is the case, nocturnal seizures may worsen Parasomnias and the Parasomnias may worsen seizure control. Up to 34% of patients with nocturnal frontal lobe epilepsy (a form of epilepsy yielding nocturnal seizures exclusively) may have a history of probable parasomnia while 39% have a first degree relative with this problem. Recent surveys have shown, however, that epilepsy patients do not have a higher frequency of Parasomnias compared to control subjects. It is important to recognize Parasomnias in patients with epilepsy as these sleep disorders are medically treated differently than epilepsy. In the same way, nocturnal seizures may be misdiagnosed as parasomnias when the reality may be the first manifestation of epilepsy in a child. It may be difficult for individuals to recognize the differences and thus, it is important to consult a specialist in sleep medicine and/or epilepsy to help with the diagnosis. In future newsletter editions we will review REM and non-state dependent parasomnias and their differences to epilepsy. Alcibiades J. Rodriguez, M.D. Diplomate, American Board of Sleep Medicine New York Sleep Institute NYU Comprehensive Epilepsy Center Assistant Professor of Neurology New York University School of Medicine 724 Second Avenue • New York, NY 10016 Telephone: 212.871.0227 • Fax: 212.871.1827 www.nysleepinstitute.com