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96 Cards in this Set
- Front
- Back
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Insomnia definition
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Defined by a repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment
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Forms of daytime impairment related to insomnia
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1) Fatigue or malaise
2) Attention, concentration, or memory impairment 3) social or vocational dysfunction or poor school perfomance 4) mood disturbance or irritability 5) daytime sleepiness 6) motivation, energy or initiative reduction 7) errors or accidents at work or while driving 8) tension, headaches, GI symptoms 9) concern or worries about sleep |
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Essential feature of adjustment insomnia (acute insomnia)
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presence of an identifiable stressor
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Time course of acute insomnia
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lasts no more than 3 months
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Adjustment Insomnia Diagnostic Criteria
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A. Patient's symptoms meet the criteria for insomnia
B. identifiable stressor C. sleep disturbance resolves when the acute stressor resolves or when the individual adapts to the stressor D. Lasts for less than 3 months E. not explained by another disorder |
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Psychophysiological Insomnia Diagnostic Criteria
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A. Symptoms meet the criteria for insomnia
B. At least one month in duration C. The patient has evidence of conditioned sleep difficulty and/or heightened arousal in bed as indicated by i - focus or anxiety about sleep ii. difficulty falling asleep in bed but no difficulty at other times iii. ability to sleep better away from home iv mental arousal in bed v heightened somatic tension in bed D. Unexplained by another disorder |
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Paradoxical insomnia - essential feature
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complaint of severe insomnia that occurs without evidence of objective sleep disturbance and without the level of daytime impairment comensurate with the degree of sleep deficits reported
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Paradoxical Insomnia Diagnostic Criteria
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A. Meets critera for insomnia
B. Duration at least one month C. Has 1+ of following criteria i. little or no sleep on most nights ii sleep-log data shows little sleep iii shows mismatch between objective findings from PSG or actigraphy D. Also pt reports i. constant or near constant awareness of stimuli ii. pattern of conscious thoughts or rumination E. much less severe daytime impairment than expected gtiven the extreme level of sleep deprivation F. no other disorder |
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Idiopathic Insomnia Diagnostic Criteria
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A. meets criteria for insomnia
B. the course of the disorder is chronic, as indicated by each of the following: i. Onset during infancy or childhood, ii. No identifiable precipitant or cause, iii Persistent course with no periods of sustained remission C. no other disorder |
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Insomnia Due to a Mental Disorder Diagnostic criteria
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A. Pt has insomnia
B. At least one month C Mental disorder diagnosed according to standard criteria D. Insomnia is temporally associated with the mental disorder E. Insomnia is more prominent than that typically associated with the menal disoders F. Not another type of insomnia |
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Inaequate Sleep Hygiene Diagnostic Criteria
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A. meet criteria for insomnia
B. insomnia is present for at least one month C. At least one of the following (1) improper sleep scheduling with naps and variable bed and rising times and naping (2) use of alcohol, nicotine and caffeine (3) engagement in mentally stim, physically activating or emotionally upsetting activities near bedtime (4) use of bed for activities other than sleep (5) failuire to maintain a comfortable sleep env't D. No other sleep disorder |
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Essential features of Behavior Insomnia of Childhood
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Difficulty falling asleep, staying asleep, or both that is related to an identified behavioral etiology
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Types of Behavioral Insomnia of Childhood
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Sleep-onset association type
Limit Setting Type |
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Behavioral Insomnia of Childhood Diagnostic Criteria
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A Meets criteria for insomnia based on parents explaination
B. Sleep onset includes (1) falling asleep is an extended process (2) sleep onset is problematic (3) without associated conditions, sleep onset is delayed (4) nighttime awakening require caregiver intervention B Limit setting type includes (1) difficulty initiating or maintaining sleep (2) refuses or stalls going to bed at an appropriate time (3) caregiver demonstrates insufficient limit setting C. no other type |
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Insomnia Due to Drug or Substance Diagnostic Criteria
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A. Meets criteria for insomnia
B. Insomnia is present for at least one month C. Either (1) ongoing dependence on or abuse of a drug or substance known to have sleep disruptive properties, or (2) ongoing use of or exposure to a medication, food, or toxin known to have sleep disruptive properties D. Insomnia is temporally associated with the substance E. no other sleep disorder |
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Insomnia Due to Medical Condition
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A. meet the criteria for insomnia
B. Insomnia is present for at least one month C. Coexisting medical or physiologic conition known to disrupt sleep D. Insomnia is associated with the medical or physiologic condition E. Not explained by other disorder |
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PSG changes from Acute Insomnia
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prolonged sleep latency
increased awakenings short overall sleep reduced sleep efficiency first REM latency prolonged Reduced SWS and and REM sleep Stage 1 and 2 NREM increased |
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PSG changes from Psychophysiological Insomnia
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Increased latency
increased wake time Increase in stage 1 Decrease in SWS MSLT shows normal daytime alertness or even hyperalertness |
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PSG changes from Paradoxical Insomnia
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no significant sleep deficits
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PSG findings for idiopathic insomnia
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increased stage 1 and 2
decreased stage 3 prolong sleep onset latency increased time awake after sleep onset |
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PSG findings for insomnia secondary to a mental disorder
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no specific changes
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PSG changes while taking stimulants
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increase sleep latency and arousals and decrease total sleep time
REM latency may be prolonged total REM time may be decreased |
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PSG changes during stimulant withdrawal
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sleep latency is reduced
total sleep time is increased REM rebound may be observed |
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PSG changes with long term BDZ use
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low percentages of stages 1,3,4 and REM
decreased K complexes decreased delta waves increased 14-Hz to 18Hz waves increased alpha and bta activity Eye movements during REM may be deduced in number |
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PSG chnagess with extended alcohol use
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decreases is stages 3 and 4
REM sleep fragmentation (may last for hears after chronic alcohol use is discontinued) |
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MSLT changes with caffeine
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individuals who comsume high daily doses of caffeine may appear pathologically sleepy on the MSLT
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Cheyne Stokes breathing pattern
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during NREM
attenuates during REM |
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High Altitude PEriodic Breathing
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A Recent ascent to altitude of at least 4,000 meters
B. PSG demonstrates recurrent central apneas primarily during NREM sleep at a frequency greater than five per hour. The cycle length should be 12 to 34 seconds |
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PSG changes in high altitude periodic breathing
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Increase stages 1 and 2
reduced stages 3 and 4 REM sleep duration and total sleep time are well preserved |
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Apnea of Prematurity vs Apnea of Infancy vs Periodic breathing
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Apnea is 20 seconds of more
Prematurity is less than 37 weeks of conceptional age Infancy is 37 weeks and older Period breathing is irregular respiration for 10-18 seconds and is benign |
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Nonobstructive Alveolar Hypoventilation, Idiopathic Diagnostic criteria
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A. PSG with shallow breathing longer than 10 seconds in duration with arterial oxygen desat and frequent arousals with the breathing disturbances or brady-tachycardia
B. No primary lung disease, skeletal malformations, or peripheral neuromuscular disorders that affect ventilation are present |
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Nonobstructive Alveolar Hypoventilation, Idiopathic - complications
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can lead to cardiac arrhythmias, pulmonary HTN, and heart failure
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Congenital Central Alveolar Hypoventilation syndrome - diagnostic criteria
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A hypoventilation which usually has its onset in infancy
B Hypoventilation is worse during sleep than during wafefulness C Rebreathing ventilatory responsive to hypoxia and hypercapnia is absent or diminished D. PSG demonstrates severe hypercapnia and hypoxia, predominantly without APNEA |
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Congenital Central Alveolar Hypoventilation syndrome - associatd with
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Hirschsprung's disease (16%) - autonomic dysfunction, neural tumors, swallowing dysfunction and ocular abnormalities
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Narcolepsy with cataplexy diagnostic criteria
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A. patient with excessive sleepiness daily for at least 3 months
B. Cataplexy - must be triggered by strong emotions, cataplexy with transient reversible loss of deep tendon reflexes B. mean sleep latency on MSLT less than or equal to 8 minutes and two or more SOREMP . Hypocretin-1 levels in the CSF are less than or equal to 100 |
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Narcolepsy without cataplexy
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A. excessive daytime sleepiness for at least 3 months
B. typical cataplexy is not present although doubtful or atypical cataplexy like episodes may be reported C. must be confirmed by a PSG followed by an MSLT - mean sleep latency on MSLT is less than or equal to 8 minutes on 2 or more SOREMPs *** the presence of two or more SOREMPs during the MSLT is a specific finding, whereas a mean sleep latency of less than eight minutes can be found in up to 30% of the normal population |
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SOREMPs
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sleep onset rapid eye movement periods - REM occurs within 10 minutes of falling asleep
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Narcolpsy Due to Medical Condition Diagnostic Criteria
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A. EXcessive daytime sleepiness daily for at least 3 months
B. One of the following (1) definite history of cataplexy (2) MSLT with mean sleep latency of less than 8 minutes with 2 or more SOREMPs (3) hypocretin levels in CSF less than 110 C. Significant underlying medical or neurological disorder accounts for the daytime sleepiness |
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Medical conditions with secondary narcolpsy
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Parkinson's disease
Postraumatic narcolepsy Genetic disorders with cataplexy - Niemann Pick, Norrie's disease, Coffin-Lowry syndrome Narcolepsy and SRBDs: myotonic dystrophy, Prader-Willi syndrome Infections or other brain lesions |
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Recurrent Hypersomnia can be seen in:
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Kleine-Levin Syndrome
Mentrual Related Hypersomnia |
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Kleine-Levin Syndrome
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Hypersomnolence
Hypersexuality Binge eating Irrability and aggressiveness Behavior is normal in between episodes Early adolescence is the usual age of onset |
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Menstrual related hypersomnia
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recurrent episodes of sleepiness that occur in association with the menstrual cycle - occurs within the first 5 months after menarche - last a week and rapidly resolve at the time of menses
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Idiopathic Hypersomnia with long sleep time
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A. EDS daily x 3 months
B - prolonged nocturanl sleep time (more than 10 hours) documented by interview, actigraphy or sleep logs - waking up in the morning is almost always laborious (sleep drunkenness) C. PSG without other causes D. PSG demonstrates a short sleep latency and a sleep period that is prolonged E. MSLT with sleep latency of less than 8 minutes and fewer than 2 SOREMPS |
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Idiopathic Hypersomnia without long sleep time
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A. EDS daily x 3 months
B - NOT prolonged nocturanl sleep time (between 6 and 10 hours) waking up in the morning is almost always laborious (sleep drunkenness) C. PSG without other causes D. PSG demonstrates a short sleep latency and a sleep period that is prolonged E. MSLT with sleep latency of less than 8 minutes and fewer than 2 SOREMPS |
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Behaviorally Induced Insufficient Sleep Syndrome - diagnostic criteria
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A. excessive sleepiness, or, in prepubertal children, a complaint of behavioral abnormalities suggesting sleepiness (at least 3 months)
B. Patient's habitual sleep episode is shorter than expected from age-adjusted normative data C. when the habitual sleep schedule is not maintained patients will sleep considerably longer than usual (weekend or vacations) D. PSG (not required) sleep latency is less than 10 min with sleep efficiency greater than 90%, - MSLT with short mean sleep latency of less than 8 minutes (with or without multiple SOREMPs) *** overall inidiviaul engages in voluntary , albeit unintentional, chronic sleep deprivation |
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Hypersomnia related to a medical condition diagnostic criteria
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A. EDS x 3 months
B. significant underlying medical or neurological disorder C. MSLT with sleep latency less than 8 minutes with no more than one SOREMP |
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General Criteria for a Circadian Rhythm Sleep Disorder
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A. Persistent or recurrent pattern of sleep disturbance due primarily to one of the following (1) alterations of the circadian timekeeping system (2) misalignment between the endogenous circadian rhythm and exogenous factors that affect the timing or duration of sleep
B. Circadian related sleep disruption leads to insomnia, ecessive daytime sleepiness, or both |
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Delayed Sleep Phase Diagnostic Criteria
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A. delay in the phase of the major sleep - inability to fall asleep at the disered conventional time and inability to awaken at a desired time
B. when allowed to choose their preferred schedule the patients will exhibit normal sleep quality and duration C. sleep log or actigraphy monitoring demonstrates a stable delay in the timing of the sleep period |
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Advanced sleep phase diagnostic criteria
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A. there is an advance in the phase of sleep of the major sleep period
B. when allowed to choose their preferred schedule, sleep quality and duration are normal C. sleep logs or actigraphy monitoring for at least 7 days demonstrates a stable advance in the timing of the sleep period |
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Circadian phythm disoder, irrgular sleep wake type
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A. chronic complaint of insomnia, excessive sleepiness or both
B Sleep logs or actigraphy monitoring for at least 7 days demonstrate multiple irrgular sleep bouts (at least 3) during a 24 hours period C. Total sleep time per 24 hour period is essentially normal for age |
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Circadian phythm sleep disorder, free-running type
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MOST COMMON IN BLIND PEOPLE
A. chronic complaint of insomnia, excessive sleepiness or both B. Sleep logs or actigrpahy monitoring for at least 7 days demonstrate multiple irrgular sleep bouts (at least 3) during a 24 hours period C. Total sleep time per 24 hours period is essentially normal for age |
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Circadian Rhythm Sleep Disorder - Shift Work Type - diagnostic criteria
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A. Insomnia or excessive sleepiness that is temporally associated with a recurring work schedule
B Symptoms are associated with the shift work schedule over the course of at least onemonth C Sleep Log or actigraphy for at least 7 days |
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Circadian Rhythm Sleep Disorder Due to a Medical Condition - diagnostic criteria
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A. EDS or insomnia due to a misaligment between the endogenous circadian rhythm and exogenous factors that affect the timing or duration of sleep
B An underlying medical or neurologic disorder accounds for the circadian rhythm sleep disorder C Sleep log or actigraphy x 7 days |
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Medical disorders associated with Circadian Rhythm Sleep Disorder
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Dementia
Parkinson's Blindness Hepatic Encephalopathy |
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Confusion Arousals Diagnostic Criteria
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A. Recurrent mental confusion or confusional behavior occurs during an arousal or awakening from nocturnal sleep or a daytime nap
** typicall from SWS ** irregular behavior when awakening including violent episodes which can last minutes to hours |
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Sleepwalking Diagnostic Criteria
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A. Ambulation occurs during sleep
B. Persistence of sleep in an altered state of consciousness or impaired judgement during ambulation is demonstrated by at least one of the following (1) Difficulty in arousing the person (2) Mental confuions when awakened froman episode (3) Amnesia (complete or partial) for the episode (4) Routine behaviors that occur at inappropriate times (5) inappropriate or nonsensical behaviors (6) dangerous or potentially dangerous behavior |
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Sleep Terror Diagnostic Criteria
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A. Sudden episode of terror occurs during sleep, usually initiated by a cry or oud scream that is accompanied by autonomic nervous system and behavioral manifestations of intense fear
B. At least one of the following (1) Difficulty in arousing the person (2) Mental confusion when awakened from an episode (3) Amnesia (complete or partial) for the episode (4) Dangerous or potentially dangerous behaviors |
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Sleep Terror features
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First 1/3 of sleep
Tachycardia, tachypnea, flushing of the skin, diaphoresis, mydriasis, increased muscle tone Usually in children aged 4-12 years but can also emerge in adulthood |
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REM Behavior Disorder
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A. REM sleep without atonia - excessive or sustained or intermittent elevation of submental EMG tone
B. At least one of the following is present: (1) Sleep related injurious behavior (2) Abnormal REM sleep behaviors documented during PSG C. Absence of EEG epileptiform activity during REM unless RBDE can be clearly distinguished from any concurrent sleep related seizure disorder |
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Parasomnia overlap disorder
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RBD combined with a disorder of arousal (confusional arousals, sleepwalking, and sleep terrors)
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Status dissociatus
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subtype of RBD that manifests as an extreme form of status dissocation without identifiable sleep stages but with sleep and dream related behaviors that closely resemble RBD - almost always associated with a disease
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Status dissociatus associated diseases
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Narcolepsy
Parkinsonism Dementia Multiple system atrophy Protracted alcohol withdrawal Recent cardiac surgery Brainstem involvement of HIV infection Fatal familial insomnia can also manifest as status dissociatus at some point in its progrossive course |
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Recurrent Isolated Sleep Paralysis
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A The patient complains of an inability to move the trunk and all limbs at sleep onset or on waking from sleep
B. Each episode lasts seconds to a few minutes ** hallucinatory experiences may be present but are not essential to the diagnosis. PSG, if performed, reveals the event to occur in a dissociated state with elements of REM sleep and wakefulness |
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Nightmare Disorder
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A. Recurrent episodes of awakenings from sleep with recall of intensely disturbing dream mentation, usually involving fear or anxiety, but also anger, sadness, disgust, and other dysphoric emotions
B. Full alertness of awakening with little confusion or disorientation; recall of sleep mentation is immediate and clear C. At least one of the following associated features is present: (1) Delatyed return to sleep after episodes (2) Occurrence of episodes in the latter half of the habitual sleep period |
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How do nightmares differ from sleep terrors
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Nightmares differ from sleep terrors in having detailed recollection of dreaming in contrast to fragments of dreams or no dream recall, presenting no or minimal overt movement or autonomic activity, occurring late in the night, being followed by rapid awakening and a difficulty return to sleep, and often involving REM sleep
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Sleep Related Dissociative disorders
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A. Dissociative disorder fulfilling the DSM IV diagnostic criteria
B. One of the following is present (1) PSG with dissociative episode or episodes that emerge during sustained EEG wakefulness, either in the transition from wakefulness to sleep or after an awakening from NREM or REM sleep (2) In the absence of a PSG, the history provided is compelling especially if the sleep related behaviors are similar to observed daytime dissociative behaviors |
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Dissociative DSM-IV definition
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a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment
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Sleep Enuresis - Primary
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A. PAtient is older than 5
B. PAtient exhibits recurrent involuntary voiding during sleep, at least 2x per week C. The patient has never consistently been dry during sleep |
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Secondary Sleep Enuresis
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A. The patient is older than 5
B. The patient exhibits recurrent involuntary voiding during sleep, occurring at least twice a week C. The patient has previously been consistently dry during sleep for at least 6 months |
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Sleep Related Groaning (Catathrenia)
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mostly in the second half of the night - recurrent bradypneic episodes that emerge mainly during REM slep: a depe inspiration is followed by protracted expiration when a monotonous vocalization is produced that closely resembles groaning
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Exploding Head Syndrome
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A. The patient complains of a sudden loud noise or sense of explosion in the head either at the wake sleep tansition or upon waking during the night
B The experience is not associated with significant pain complaints C. The patient rouses immediately after the event, usually with a sense of fright ** in a minority of cases a flash of light or myoclonic jerk may accompany the event |
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Sleep Related Hallucinations
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A. The patient experiences hallucinations just prior to sleep onset or on awakening during the night or in the morning
B. The hallucinations are predominantly visual ** hypnagogic or hypnopompic hallucinations may be difficult to differentiate from sleep onset or sleep termination dreaming. Complex nocturnal visual hallucinations may clearly occur in wakefulness following suden arousal during the night. |
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Sleep Related Eating Disorder associated medications and disorders
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Zolpidem
Triazolam Lithium Anticholinergic medications associated with cessation of cigarette smoking, cessation of alcohol and substance abuse, with acute stress, after daytime dieting, with onset of narcolepsy, automimmune hepatitis, encephalitis |
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Sleep Related Eating Disorder diagnostic criteria
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A. Recurrent episodes of involuntary eating and drinking occur during the main sleep period
B. One of more of the following must be present with the recurrent episodes (1) Consumption of peculiar forms and combinations of foods (2) insomnia related to sleep disruption (3) sleep injury (4) dangerous behavior performed while in pursuit of food or while cooking food (5) morning anorexia (6) adverse health consequences from recurrent binge eating of high caloric foods |
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RLS Diagnostic criteria for adults
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A. pt reports an urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs
B. Urge to move or the unpleasant sensations begin or woresens during periods of rest or inactivity C. The urge or move or the unpleasant sensations are partially or totally relieved by movement D. The urge to move or unpleasant senations are worse, or only occur, in the evening or night |
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RLS Diagnostic critera for children (2-12 yo)
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A alone or B and C
A. The child meets all four essential adult criteria for RLS B. The child meets all four essential adult criteria but does not relate a description in his or her own words that is consistent with leg discomfort C. The child has at least two of the following (1) a sleep disturbance for age (2) biological parent or sibling with definite RLS (3) PSG with 5 or more period limp movements per hour |
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Secondary RLS
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Pregnancy
Iron deficiency end stage renal disease |
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Neuroleptic-induced akathisia
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differs from RLS in the generalized nature of the need to move the body and the occurrence in association with use of dopamine receptor antagonists
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PLMD vs RLS
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present only in sleep without any of the essential diagnostic features of RLS
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PLMD diagnostic criteria
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A. PSG demonstrates repetititve, highly stereotyped limb movements that are (1) .5 to 5 seconds in duration (2) of amplitude greater than or equal to 25% of toe dorsiflexion during calibration (3) in a sequence of 4 or more movements (4) separated by an interval of more than 5 seconds and less than 90 seconds
B. PLMS index greater than 5 in children and 15 per hour in adults C. clinical sleep disturbance or a complaint of daytime fatigue |
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PLMS without clinical sleep disturbance
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If the PLMS are present without clinical sleep disturbance, the PLMS can be noted as a PSG finding, but criteria are not met for a diagnosis of PLMD
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Sleep Related LEg Cramps
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A. Painful sensation in the leg or foot is associated with sudden muscle hardness or tightness
B. The painful muscle contractions in the legs or feet occur during the sleep period, although they may arise from either wakefulness or sleep C. The pain is relieved by forceful streching of the affected muscles |
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Sleep Related Bruxism
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A. The patient reports or is aware of tooth grinding sounds or tooth clenching during sleep
B. One or more of the following is present (1) abnormal wear of the teeth (2) jaw muscle discomfort, fatigue, or pain and jaw lock upon awakening (3) maseter muscle hypertrophy |
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Sleep Related Rhythmic Movement Disorder
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A. The patient exhibits repeatitive stereotyped and rhytmic motor behaviors
B. The movements involve large muscle groups C. The movements are predominantly sleep related, occurring near nap or bedtime or when the indiviidual appears drowsy or asleep D. The behvaiors result in at least one of (1) interference with normal sleep (2) significant impairment in daytime function (3) self inflicted b odily injury |
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Sleep related rhythmic movement disorder - facts
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Mostly in stage 2
Often seen in autistic or severe mentally retarded Mostly in children |
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Types of Sleep related rhythmic movement disorder
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Body Rocking Type
Head Banging Type Head rolling type Other typeS Combined type |
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Long Sleeper
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Sleep time greater than 10 hours (or two hours longer than age appropriate)
Do not need PSG |
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Short sleeper
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A The patient presents with concerns about an inability to sleep as long as most others
B. Sleeps less than 5 hours per night C. No daytime sleepines or other daytime impairment |
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Benign sleep myoclonus of infancy
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A. Repetitive myoclonic jerks involve the whole body, trunk or limbs
B. The movements occur in early infancy, typically from birth to six months of age C. The movements occur only during sleep D. Movements stop abruptly and consistently when the infant is aroused |
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Hypnagogic Foot Tremor
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A. The patient reports foot movements that occur at the transition between wake and sleep or during light sleep
B. PSG demonstrates (1) recurrent EMG potentials or foot movements typically at the 1 - 2 Hz range in one or both feet (2) burst potentials longer than the myoclonic range and usually less than one second (3) trains lasting 10 seconds |
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Alternating Leg Muscle Activation
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A. PSG demonstrates a pattern of brief, repeated activation of the anterior tibialis in one leg alternativng with similar activation in the other leg
B. At least 4 discrete and alternating muscle activations occur with less than 2 seconds between activations C. Individual activations last between .1 and .5 seconds and occur at a frequency of .5 to 3 Hz D. Sequences of alternating activations last between one and 30 seconds and may recur periodically |
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Propriospinal Myoclonus at sleep onset
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A. The patient complains of sudden jerks, mainly or the abdomen, trunk and neck
B. The jerks arise upon relaxed wakefulness and drowsiness and disappear upon mental activation and at sleep onset |
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Excessive fragmentary myoclonus
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A. The patient exhibits small movements of the fingers, toes, or corners of the mouth or small muscle twitches, resembling either physiologic hypnic myoclonus or fasciculations. The movements may be present during wakefulness or sleep. ** movements do not cross the joint space - patients are typically unaware - usually represents an incidental EMG finding on PSG - daytime sx are not required
B. PSG demonstrates recurrent and persistent very brief (75 to 150 millisecond) EMG potential in various muscles occurring asynchronously and asymmetrically in a sustained manner without lcustering C. More than 5 potentials per minute are sustained for at least 20 minutes of NREM stages 2,3, or 4 sleep |
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Environmental Sleep disorder
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a disturbing environmental factor that cuases a complaint of either insomnia or daytime fatigue and somnolence
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Fatal Familial insomnia diagnostic criteria
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A, B, C and D are present or just E
A. Insomnia is initially present and becomes progressively more severe B. Progressive autonomic hyperactivity with pyrexia, excessive salivation, hyperhydrosis, cardiac and respiratory dysfunction, and myoclonus and tremor-like muscle activity are present C. PSG has one or more of (1) loss of sleep spindles (2) loss of slow wave (3) dissociated sleep D. no other disorder - or - E. missense GAC to AAC mutation at codon 187 or the PRNP gene cosegregating with the methionine polymorphism at codon 129 of the PRNP on the mutated allele is found |
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Sleep related epilepsy
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A. At least two of the following (1) abrupt awakenings from sleep (2) generalized tonic clionc movements (3) focal limb movements (4) facial twitching (5) automatisms (6) urinary incontinence (7) tongue biting (8) postical confuion and lethargy
B. more than 70% of the episodes occur during sleep C PSG with (1) epileptiform EEG discharge in association with the symptom, or (2) interictal epileptiform EEG activity in any stage of sleep **** a normal EEG does not rule out a diagnosis of epilepsy |
