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Clinical Cases and Reviews in Epilepsy

Myoclonic status triggered by NREM parasomnia

Brief report/Clinical case, 40 - 43
doi: 10.11138/ccre/2016.1.1.040
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Abstract
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Introduction: NREM disorders of arousal and sleep epilepsies have overlapping clinical manifestations, in relation to a probable common etiopathogenetic substrate. The case we present is representative of the relationship between the phenomenon of partial arousal, typical of parasomnias, and generalized seizures in Juvenile Myoclonic Epilepsy (JME).
Clinical description: a 15 year-old boy with a family and personal history of parasomnias, came to our observation for recurrent nocturnal events of involuntary jerks of the limbs. The physical and neurological examinations were normal, as well as the cognitive profile and neuroimaging. An EEG showed epileptiform abnormalities over both frontal regions. The video-polysomnography (VPSG) revealed, in stage N3, episodes of partial arousal suggestive of NREM parasomnias. One of these events induced discharges of polyspikes and waves related to generalised myoclonus of the limbs for more than one hour, representing a myoclonic status. This phenomenology showed a good response to valproate. After 1 month of treatment another VPSG was performed. The patient had no more episodes of myoclonic status but continued to experience nocturnal episodes related to NREM parasomnias. One year later he was seizure free and he had no more parasomnia events.
Conclusions: epilepsy and sleep have a profound bidirectional influence. It is already ascertained the close relationship between JME and the sleeparousal system. The presented case is emblematic of the close relationship between disorders of arousal and epilepsy. To our knowledge it is the first case in the literature of a myoclonic status, as an initial symptom of JME, precipitated by a NREM parasomnia.

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