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A 16-Year-Old Male With Frequent Nocturnal Events During Slow Wave Sleep on a Polysomnogram

Sameh S Morkous¹

¹Pediatric Neurology, Lehigh Valley Health Network (LVHN) Lehigh Valley Reilly Children's Hospital, Allentown, USA.

|October 25, 2021

Insights

A 16-year-old male diagnosed with night terrors was correctly identified as having Sleep-related Hypermotor Epilepsy (SHE) seizures. Video polysomnography (PSG) is crucial for differentiating SHE seizures from parasomnias.

Area of Science:

Neurology
Sleep Medicine
Epileptology

Background:

Parasomnias, such as night terrors, can present with disruptive nocturnal events.
Differentiating between parasomnias and nocturnal seizures is clinically challenging.
Accurate diagnosis is essential for appropriate patient management and treatment.

Observation:

A 16-year-old male presented with a two-year history of screaming episodes during sleep, initially diagnosed as night terrors.
Video polysomnography (PSG) captured these events, revealing their true nature.
The patient was ultimately diagnosed with Sleep-related Hypermotor Epilepsy (SHE) seizures.

Findings:

The diagnostic distinction between night terrors (a parasomnia) and Sleep-related Hypermotor Epilepsy (SHE) seizures is critical.
Video-PSG is an indispensable tool for accurately diagnosing SHE seizures.
Misdiagnosis can lead to delayed or incorrect treatment for patients with nocturnal epilepsy.

Implications:

Sleep medicine providers, especially those from diverse academic backgrounds, must be vigilant in differentiating parasomnias from nocturnal seizures.
This case underscores the importance of advanced diagnostic tools like video-PSG in sleep medicine.
Improved diagnostic accuracy for SHE seizures can lead to better patient outcomes and epilepsy management.

Read full analysis

Abstract:

A 16-year-old male was referred by the primary care physician (PCP) for a second opinion. An initial evaluation in another sleep center suggested a working diagnosis of night terrors for the last two years. The child would wake up frequently screaming for few minutes before going back to sleep with no recollection of these events later. A video during the polysomnography (PSG) showed the patient having one of his typical events. He was eventually diagnosed with Sleep-related Hypermotor Epilepsy (SHE) seizures. This case highlights the importance of differentiating parasomnia and seizures, particularly for the sleep medicine providers that incorporate providers from different academic backgrounds. We will discuss the clinical challenges to make the distinction for the referring providers and demonstrate the importance of video-PSG to establish the diagnosis.

Keywords:

focal seizures parasomnia pediatric neurology pediatric sleep disorders seizures

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