Dai risvegli confusi al sonnambulismo: aspetti clinici, videopolisonnografici e diagnosi differenziale dei disturbi dell'arousal nell'adulto

Introduction Arousal Disorders (DOA) include Confusional Arousal, Sleepwalking and Sleep Terrors. Adult DOA do not seem to be harmless, as in childhood, and need to be differentiated from other sleep disorders such as Sleep Hypermotor Epilepsy (SHE) in which seizures have an increasing intensity and duration ranging from paroxysmal arousal to hyperkinetic seizures and epileptic nocturnal wandering. Objectives To describe the clinical and semeiological features of DOA in adulthood; to characterize the motor features of the episodes in order to identify key features that can assist in the differential diagnosis with SHE. Methods The study involved adult DOA and SHE patients and healthy subjects who underwent a full-night videopolysomnography (VPSG). All VPSGs were analyzed by 2 neurologists with experience in sleep disorders and epilepsy who identified all movements and episodes arising from sleep. Results Sixty DOA, 30 SHE patients, and 15 healthy subjects have been enrolled. A total of 114 VPSG have been analyzed, 334 DOA and 140 paroxysmal arousals have been recorded. Three semeiological motor patterns with increasing intensity and complexity have been identified: simple arousal movements, rising arousal movements and complex arousal with ambulatory movements. Duration, sleep stage at onset, limb involvement, movement progression and behaviours are different in the briefest episodes of SHE and DOA. Episodes occurred mostly during N3 and N2 NREM sleep stage in DOA and SHE patients respectively. Conclusions The study described clinical and semeiological features of DOA in adulthood identifying key features that can assist in the differential diagnosis with SHE.