Derangments of the Sleep Process

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While it is certain that all the funny turns which may occur in the daytime have not yet been properly described in the literature, it is even more likely that the disorders of the sleep process are by no means fully described. There are great intrinsic difficulties in readily determining what happens during sleep. Even ordinary visual observation may be difficult, whereas videorecording and, even more, polygraphic recording, may only be possible in exceptional cases where episodes are very frequent. It is important to recognize that all parasomnias have not yet been described and to question carefully the origin of any episode which occurs only during sleep, even though some disorders previously thought to be parasomnias have now been found to be epileptic.3

The parasomnias and neurological sleep disorders such as narcolepsy may be confused with epilepsy due to their paroxysmal nature. The difficulties in distinguishing epileptic and nonepileptic events is compounded by the fact that paroxysmal nonepileptic sleep events are more common in children with epilepsy or ID than in the general childhood population. Sleep disorders remain a largely neglected and poorly understood area in pediatrics; however, with careful attention to the timing and semiology of events and the use of video EEG and nocturnal polysomnography these conditions can be classified and differentiated from epileptic seizures.

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