Video-Clinical CornersGastroesophageal reflux-related Non-Rapid Eye Movement parasomnia mimicking sleep-related hypermotor epilepsy
Introduction
NREM parasomnias often share clinical semiology with Sleep Related Hypermotor Epilepsy or SHE [1]. NREM parasomnia can also be triggered by physiological and pathological arousals [2]. We present a case of patient referred for an epilepsy clinic for the evaluation of SHE who had NREM parasomnia triggered by gastroesophageal reflux (GER).
Section snippets
Case description
A 44-year-old woman presented with a four-year history of recurrent paroxysmal episodes out of sleep. She would abruptly sit up in bed, scream, feel like she can't breathe, thrash around and sometimes fall out of bed. These events usually lasted for a few seconds and were followed by throat discomfort. She usually drank water and fell back asleep. In most cases she had no recollection of the events, the semiology was provided by her husband. Initially the events occurred 3–4 times per month and
Video description
Video 1. Patient's typical event: she suddenly awakes from slow-wave sleep and balances herself on her hands and knees, yelling and thrashing around. Afterwards the patient reported that during the event, she experienced throat discomfort, anxiety, and breathlessness. She does not, however, recall the yelling and the screaming.
The following is the supplementary data related to this article: . 2
Brief discussion
Differential diagnosis of nocturnal motor events includes SHE, Non-Rapid Eye Movement (NREM) parasomnia and psychogenic nonepileptic seizures (PNES). Psychogenic nature was excluded since all recorded episodes arose out of EEG confirmed stage N3 sleep. So, SHE and NREM parasomnia remained the main diagnostic considerations.
SHE is commonly characterized by occurrence of brief (<2 min) seizures with stereotyped hyperkinetic patterns, abrupt onset and end [4]. It is well known that both interictal
Credit author statement
Conception or design of the work: Dr Pushkar, Dr Broutian and Dr Belyakova-Bodina.
Data collection: Dr Pushkar, Dr Broutian and Dr Belyakova-Bodina.
Data analysis and interpretation. Dr Pushkar, Dr Attarian and Dr Broutian.
Drafting the article. Dr Pushkar.
Critical revision of the article. Dr Attarian.
Final approval of the version to be published Dr Pushkar, Dr Broutian, Dr Attarian and Dr Belyakova-Bodina.
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