"Nocturnal seizures" in idiopathic pulmonary arterial hypertension

Area of Science:

• Pediatric Sleep Medicine
• Pediatric Cardiology
• Pulmonology

Background:

• Nocturnal events in children often prompt differential diagnoses including parasomnias and seizures.
• Accurate diagnosis is crucial for appropriate management of pediatric sleep disturbances.

Observation:

• A previously healthy young girl presented with nocturnal events initially diagnosed as medically refractory nocturnal seizures.
• A daytime syncopal event led to cardiac evaluation, revealing idiopathic pulmonary arterial hypertension (IPAH).

Findings:

• The patient's nocturnal events were ultimately attributed to undiagnosed IPAH, not seizures.
• This case highlights a potential diagnostic challenge where cardiac conditions mimic primary sleep disorders.

Implications:

• Sleep physicians should broaden the differential diagnosis for nocturnal events in children to include conditions like IPAH.
• Early consideration of IPAH can prevent misdiagnosis and delayed treatment of serious cardiopulmonary disease.
• Integrating cardiac evaluation into the workup of refractory nocturnal events may be warranted.