Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions?
Introduction: Differential diagnosis between disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) often represents a clinical challenge. The two conditions may be indistinguishable from a semiological point of view and the scalp video-polysomnography is often uninformative. Both di...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-12-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2020.600026/full |
| _version_ | 1818435618165751808 |
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| author | Carlotta Mutti Giorgia Bernabè Noemi Barozzi Rosario Ciliento Irene Trippi Giuseppe Pedrazzi Nicoletta Azzi Liborio Parrino |
| author_facet | Carlotta Mutti Giorgia Bernabè Noemi Barozzi Rosario Ciliento Irene Trippi Giuseppe Pedrazzi Nicoletta Azzi Liborio Parrino |
| author_sort | Carlotta Mutti |
| collection | DOAJ |
| description | Introduction: Differential diagnosis between disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) often represents a clinical challenge. The two conditions may be indistinguishable from a semiological point of view and the scalp video-polysomnography is often uninformative. Both disorders are associated with variable hypermotor manifestations ranging from major events to fragments of a hierarchical continuum of increasing intensity, complexity, and duration. Given their semiological overlap we decided to explore the sleep texture of DoA and SHE seeking for similarities and differences.Methods: We analyzed sleep macrostructure and CAP (cyclic alternating pattern) parameters in a cohort of 35 adult DoA patients, 40 SHE patients and 24 healthy sleepers, all recorded and scored in the same sleep laboratory. Nocturnal behavioral manifestations included minor motor events, paroxysmal arousals and major attacks in SHE, and simple, rising, or complex arousal movements in DoA.Results: Compared to healthy controls, DoA and SHE showed similar amounts of sleep efficiency, light sleep, deep sleep, REM sleep, CAP subtypes. Both groups also showed slow wave sleep fragmentation and an increased representation of stage N3 in the second part of the night. The only discriminating elements between the two conditions regarded sleep length (more reduced in DoA) and sleep instability (more elevated in SHE). In DoA recordings, all motor episodes arose from NREM sleep: 37% during light NREM stages and 63% during stage N3 (simple arousal movements: 94%). In SHE recordings, 57% of major attacks occurred during stage N3.Conclusions: So far, emphasis has been placed on the differentiation of sleep-related epilepsy and NREM arousal disorders. However, the impressive analogies between DoA and SHE suggest the existence of an underestimated continuum across the conditions, linked by increased levels of sleep instability, higher amounts of slow wave sleep and NREM/REM sleep imbalance. Sleep texture is extremely similar in the two conditions, although CAP metrics disclose quantitative differences. In particular, SHE patients show a higher arousal instability compared to DoA subjects. Given their clinical and epidemiological overlap, a common genetic background is also hypothesized. In such a perspective, we suggest that the consolidated dichotomy DoA vs. SHE should be reappraised. |
| first_indexed | 2024-12-14T16:55:45Z |
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| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-14T16:55:45Z |
| publishDate | 2020-12-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-40c7232c196f45aba7d146761ab8c4492022-12-21T22:53:57ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-12-011110.3389/fneur.2020.600026600026Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions?Carlotta Mutti0Giorgia Bernabè1Noemi Barozzi2Rosario Ciliento3Irene Trippi4Giuseppe Pedrazzi5Nicoletta Azzi6Liborio Parrino7Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, ItalyDepartment of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, ItalyDepartment of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, ItalyDepartment of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, ItalyDepartment of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, ItalyUnit of Neuroscience & Interdepartmental Center of Robust Statistics, Department of Medicine and Surgery, University of Parma, Parma, ItalyDepartment of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, ItalyDepartment of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, ItalyIntroduction: Differential diagnosis between disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) often represents a clinical challenge. The two conditions may be indistinguishable from a semiological point of view and the scalp video-polysomnography is often uninformative. Both disorders are associated with variable hypermotor manifestations ranging from major events to fragments of a hierarchical continuum of increasing intensity, complexity, and duration. Given their semiological overlap we decided to explore the sleep texture of DoA and SHE seeking for similarities and differences.Methods: We analyzed sleep macrostructure and CAP (cyclic alternating pattern) parameters in a cohort of 35 adult DoA patients, 40 SHE patients and 24 healthy sleepers, all recorded and scored in the same sleep laboratory. Nocturnal behavioral manifestations included minor motor events, paroxysmal arousals and major attacks in SHE, and simple, rising, or complex arousal movements in DoA.Results: Compared to healthy controls, DoA and SHE showed similar amounts of sleep efficiency, light sleep, deep sleep, REM sleep, CAP subtypes. Both groups also showed slow wave sleep fragmentation and an increased representation of stage N3 in the second part of the night. The only discriminating elements between the two conditions regarded sleep length (more reduced in DoA) and sleep instability (more elevated in SHE). In DoA recordings, all motor episodes arose from NREM sleep: 37% during light NREM stages and 63% during stage N3 (simple arousal movements: 94%). In SHE recordings, 57% of major attacks occurred during stage N3.Conclusions: So far, emphasis has been placed on the differentiation of sleep-related epilepsy and NREM arousal disorders. However, the impressive analogies between DoA and SHE suggest the existence of an underestimated continuum across the conditions, linked by increased levels of sleep instability, higher amounts of slow wave sleep and NREM/REM sleep imbalance. Sleep texture is extremely similar in the two conditions, although CAP metrics disclose quantitative differences. In particular, SHE patients show a higher arousal instability compared to DoA subjects. Given their clinical and epidemiological overlap, a common genetic background is also hypothesized. In such a perspective, we suggest that the consolidated dichotomy DoA vs. SHE should be reappraised.https://www.frontiersin.org/articles/10.3389/fneur.2020.600026/fulldisorders of arousalparasomniasleep-related hypermotor epilepsySHEcyclic alternating patternCAP |
| spellingShingle | Carlotta Mutti Giorgia Bernabè Noemi Barozzi Rosario Ciliento Irene Trippi Giuseppe Pedrazzi Nicoletta Azzi Liborio Parrino Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? Frontiers in Neurology disorders of arousal parasomnia sleep-related hypermotor epilepsy SHE cyclic alternating pattern CAP |
| title | Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? |
| title_full | Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? |
| title_fullStr | Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? |
| title_full_unstemmed | Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? |
| title_short | Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? |
| title_sort | commonalities and differences in nrem parasomnias and sleep related epilepsy is there a continuum between the two conditions |
| topic | disorders of arousal parasomnia sleep-related hypermotor epilepsy SHE cyclic alternating pattern CAP |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2020.600026/full |
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