Polysomnographic features differentiating disorder of arousals from sleep-related hypermotor epilepsy. Issue 12 (14th October 2019)

• Record Type: Journal Article
• Authors: Proserpio, Paola; Loddo, Giuseppe; Zubler, Frederic; Ferini-Strambi, Luigi; Licchetta, Laura; Bisulli, Francesca; Tinuper, Paolo; Agostoni, Elio Clemente; Bassetti, Claudio; Tassi, Laura; Menghi, Veronica; Provini, Federica; Nobili, Lino
• Is Part Of: Sleep. Volume 42:Issue 12(2019)
• Publication Date: 2019-10-14
• Subjects: parasomnia -- sleep-related hypermotor epilepsy -- disorder of arousal; Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz166
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Objective: The differential diagnosis between sleep-related hypermotor epilepsy (SHE) and disorders of arousal (DOA) may be challenging. We analyzed the stage and the relative time of occurrence of parasomnic and epileptic events to test their potential diagnostic accuracy as criteria to discriminate SHE from DOA. Methods: Video-polysomnography recordings of 89 patients with a definite diagnosis of DOA (59) or SHE (30) were reviewed to define major or minor events and to analyze their stage and relative time of occurrence. The "event distribution index" was defined on the basis of the occurrence of events during the first versus the second part of sleep period time. A group analysis was performed between DOA and SHE patients to identify candidate predictors and to quantify their discriminative performance. Results: The total number of motor events (i.e. major and minor) was significantly lower in DOA (3.2 ± 2.4) than in SHE patients (6.9 ± 8.3; p = 0.03). Episodes occurred mostly during N3 and N2 in DOA and SHE patients, respectively. The occurrence of at least one major event outside N3 was highly suggestive for SHE ( p = 2*e-13; accuracy = 0.898, sensitivity = 0.793, specificity = 0.949). The occurrence of at least one minor event during N3 was highly suggestive for DOA ( p = 4*e-5; accuracy = 0.73, sensitivity = 0.733, specificity = 0.723). The "event distribution index" was statistically higher in DOA for total ( p = 0.012) and major events ( p = 0.0026). Conclusion: The stage and the relative time of occurrence of minor and major motor manifestations represent useful criteria to discriminate DOA from SHE episodes.