Interictal, potentially misleading, epileptiform EEG abnormalities in REM sleep behavior disorder

Related Experiment Video

Updated: Aug 6, 2026

Manipulation of Epileptiform Electrocorticograms (ECoGs) and Sleep in Rats and Mice by Acupuncture
09:06

Manipulation of Epileptiform Electrocorticograms (ECoGs) and Sleep in Rats and Mice by Acupuncture

Published on: December 22, 2016

Raffaele Manni1, Michele Terzaghi, Elena Zambrelli

  • 1Unit of Sleep Medicine and Epilepsy, IRCCS C. Mondino Institute of Neurology Foundation, Pavia, Italy. raffaele.manni@mondino.it

Sleep
|August 10, 2006
PubMed
Abstract

Insights

Interictal epileptiform abnormalities (IEA) can be present in idiopathic REM-sleep behavior disorder (RBD), potentially leading to misdiagnosis as seizures. Full polysomnography is crucial for accurate RBD diagnosis.

Area of Science:

  • Neurology
  • Sleep Medicine
  • Epileptology

Background:

  • Idiopathic REM-sleep behavior disorder (RBD) involves dream-enacting behaviors during REM sleep.
  • Interictal epileptiform abnormalities (IEA) are EEG findings observed between seizures.
  • Distinguishing RBD from nocturnal seizures is critical for appropriate management.

Purpose of the Study:

  • To investigate the occurrence and implications of IEA in patients with idiopathic RBD.
  • To assess the risk of misdiagnosing RBD episodes as epileptic nocturnal seizures.
  • To determine the utility of extended EEG and polysomnography in differentiating these conditions.

Main Methods:

  • Observational analysis and review of patients referred for nocturnal paroxysmal episodes.
  • Inclusion of 30 patients diagnosed with idiopathic RBD via standard clinical and videopolysomnographic criteria.
  • Utilized routine and extended EEG montages, including during REM sleep, and full-night polysomnography.

Main Results:

  • IEA were detected in 26.6% of idiopathic RBD patients, including during REM sleep in two cases.
  • Clinical history alone can lead to confusion between RBD and nocturnal focal seizures.
  • No demographic or clinical differences were found between RBD patients with and without IEA.

Conclusions:

  • IEA in idiopathic RBD may be a nonspecific finding, potentially related to brain aging.
  • Extended EEG and polysomnography are essential for accurate diagnosis of RBD in cases with potential epileptic features.
  • IEA should not automatically lead to a diagnosis of epilepsy in patients presenting with RBD symptoms.

More Related Videos

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy10:22

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

Published on: December 6, 2016

Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy09:57

Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy

Published on: September 20, 2024

Related Concept Videos

REM Sleep Behavior Disorder01:15

REM Sleep Behavior Disorder

REM Sleep Behavior Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis that normally occurs during the REM phase of sleep. This absence allows individuals to physically act out their dreams, which are often vivid and disturbing. Common behaviors exhibited during episodes include kicking, punching, and yelling. These actions can be dangerous, potentially leading to injuries for the person with RBD or their bed partner.
RBD is significantly associated with...
Sleep-Wake Cycles01:24

Sleep-Wake Cycles

Sleep is an essential physiological process vital to maintaining overall well-being. The reticular activating system (RAS), a network of neurons in the brainstem, regulates wakefulness and sleep. While it may seem passive, sleep consists of distinct cycles, each with its unique characteristics and functions. Two key sleep phases are non-rapid eye movement (NREM) and  rapid eye movement (REM).
NREM Sleep
NREM sleep comprises four progressive stages that seamlessly merge:
Stages of Sleep01:22

Stages of Sleep

Sleep progresses through distinct stages, each characterized by specific brain wave patterns and physiological responses ranging from wakefulness to stages of non-rapid eye movement, known as non-REM, to rapid eye movement, referred to as REM. Understanding these stages helps in recognizing how sleep supports various bodily and cognitive functions.
Before sleep begins, in wakefulness, the brain exhibits primarily beta waves, which are high in frequency and low in amplitude, indicating alertness...