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Nocturnal events in children: When and how to evaluate
Hillary Eichelberger1, Aaron L A Nelson2
1The Department of Neurology, NYU Langone Health, New York, NY, United States.
Insights
Pediatric nocturnal events, including seizures and sleep disorders, require careful clinical evaluation. Understanding normal patterns aids diagnosis, with electroencephalography (EEG) or polysomnography (PSG) guiding management.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Clinical Diagnosis
Background:
- Nocturnal events are common concerns for patients and caregivers.
- Primary care physicians need to distinguish normal sleep behaviors from abnormal events.
- Abnormal events include nocturnal seizures, parasomnias, sleep-related movement disorders, and breathing disorders.
Purpose of the Study:
- To provide a guide for healthcare providers on evaluating nocturnal events in pediatric and adolescent patients.
- To clarify when referral for electroencephalography (EEG) or polysomnography (PSG) is indicated.
- To assist in the diagnosis, management, and prognosis of epileptic and non-epileptic nocturnal disorders.
Main Methods:
- Comprehensive literature review of nocturnal and sleep-related disorders.
- Discussion of clinical features distinguishing various nocturnal events.
- Guidance on the appropriate use of EEG and PSG.
Main Results:
- Nocturnal seizures, parasomnias, and movement disorders can often be diagnosed clinically.
- Sleep-related breathing disorders present differently in children and adults, requiring early recognition.
- Referral for EEG or PSG is sometimes necessary, while clinical assessment suffices at other times.
Conclusions:
- Accurate diagnosis of nocturnal events relies on understanding normal sleep patterns and knowing when to utilize specialized tests like EEG and PSG.
- Effective management involves parental reassurance, watchful waiting, or specific treatments, depending on the diagnosis.
- Collaboration among healthcare providers is crucial for holistic, long-term care of pediatric patients with nocturnal disorders.
Abstract:
Nocturnal events of wide variety and concern are frequently reported by patients and their caregivers. To evaluate suspected abnormal events, primary care physicians must first be familiar with normal behaviors, movements and breathing patterns. Abnormal nocturnal events can then be categorized as nocturnal seizure, parasomnia, sleep-related movement disorder or sleep-related breathing disorder. Diagnoses in the above categories can be made clinically; however, it is important to know when to refer for additional evaluation. Comprehensive literature review was undertaken of nocturnal and sleep-related disorders. This guide reviews nocturnal seizures, normal and abnormal nonepileptic movements and behaviors, discusses broad indications for referral for electroencephalography (EEG) or polysomnography (PSG), and guides counseling and management for patients and their families, ultimately aiding in interpretation of both findings and prognosis. Epilepsy syndromes can result in seizures during sleep or adjacent periods of wakefulness. Parasomnias and sleep-related movement disorders tend to also occur in childhood and may be distinguished clinically. Referral to additional specialists for specific studies including EEG or PSG can be necessary, while other times a knowledgeable and vigilant clinician can contribute to a prompt diagnosis based on clinical features. Nocturnal events often can be managed with parental reassurance and watchful waiting, but treatment or evaluation may be needed. Sleep-related breathing disorders are important to recognize as they present very differently in children than in adults and early intervention can be life-saving. This review should allow both primary and subspecialty non-neurologic pediatric and adolescent health care providers to better utilize EEG and PSG as part of a larger comprehensive clinical approach, distinguishing and managing both epileptic and nonepileptic nocturnal disorders of concern while fostering communication across providers to facilitate and coordinate better holistic long-term care of pediatric and adolescent patients.
