Cesare T Lombroso
A 6-year-old boy was referred because of nightly events thought to be nightmares. These events had started when he was 4 years old and had progressively increased until they happened several times a night. They adversely affected his daytime performance and caused stress in the family.
No benefit had been obtained from benzodiazepines or counseling with a behavioral therapist familiar with sleep disorders. His past medical history was unremarkable. There was some relevant family background: a sibling, an aunt and a cousin had suffered from febrile convulsions, the cousin later developing non-febrile seizures.
The patient had normal general and neurological examinations. Metabolic screening and scalp EEGs were normal. He was admitted for scalp video-EEG long-term monitoring (LTM). Several stereotypical events were captured, all occurring at night. He would awaken from quiet, non-rapid eye movements (non-REM) sleep, sit up looking frightened and seeking and grabbing his mother, and fleetingly exhibit dystonic posturing of his flexed left arm. There were also several bouts of a dry cough without drooling. The events lasted less then 1 minute, after which he quickly returned to sleep. Similar episodes recurred between four and eight times during the night. In the morning he had some vague recollection of the events and specifically stated that he had awoken because of 'fear and a feeling in my throat'.
The accompanying ictal EEG showed an arousal pattern out of non-REM sleep and, amidst muscle artifacts, some bilateral frontal low-voltage theta activity. An ictal single-photon emission computed tomography scan demonstrated an area of hyperperfusion within the left frontotemporal lobes. A magnetic resonance imaging scan was normal.
*Case published in part (Epilepsia 2000; 41:1221—26).
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