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This chapter discusses the case of an 11-year-old Asian-American girl who was admitted for treating sleep disturbances, excessive daytime sleepiness (EDS) and paroxysmal weakness in the sleep center. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. Nocturnal video-polysomnography (PSG) followed by a multiple sleep latency test (MSLT) were ordered. She went into REM sleep, without going into any other sleep stages at the beginning of the MSLT in three of the five naps. The diagnosis was narcolepsy with cataplexy. Sodium oxybate was administered and titrated twice nightly, which helped further decrease her cataplexy to once or twice daily. Cataplexy may take the form of prolonged waxing and waning, with partial or complete muscle atonia, called status cataplecticus. Schizophreniamay be co-morbid or an intrinsicmanifestation of narcolepsy. Obesity is frequently observed in association with narcolepsy, contributing to sleepiness.
This chapter discusses the case of a 38-year-oldwoman who had presented to the sleep center's outpatient clinic for evaluation of frequent sleepwalking episodes. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. A comprehensive evaluation including polysomnography (PSG), video-electroencephalography (EEG), psychological testing and necessary medical testing is important as it can have a major impact on the question of the patient's criminal responsibility. The EEG showed no epileptiform abnormalities interictally or during the events. The patient was referred for hypnotherapy and cognitive behavioral therapy (CBT) for her insomnia. Given these results, a diagnosis of sleepwalking, arousal disorder, was made. The daytime sleepiness was thought to be due to the intake of excess clonazepam. Medications (lithium, zolpidem, high doses of neuroleptic drugs and benzodiazepines) and recreational drugs may also induce sleepwalking.
This chapter presents the case of a 24-year-old woman who presented with 5-year history of hallucinations during night, occurring three to four times a week. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The polysomnography (PSG) study has revealed sleep latency of 11 minutes and REM sleep latency of 99 minutes. Sleep efficiency was 81% with normal distribution of sleep stages. Her apnea-hypopnea index (AHI) was 3 per hour and periodic limb movement (PLM) index was 4 per hour. The patient is awake from stage N2 sleep at 2.05am without any obvious precipitating cause. She describes seeing a woman standing by her bed. The EEG showed an alpha rhythm commencing immediately on waking and persisting for several minutes, and a review of the EEG recorded over the rest of the night showed no potentially epileptogenic activity.
This chapter presents the case study of a male adult sleepwalker with recurrence of sleepwalking events previously suffered in childhood. It describes the clinical history, examination, and the results of the procedures performed and the results obtained. He had a history of sleep-walking in childhood but stopped exhibiting events after the age of 14 years. The patient underwent polysomnography (PSG) because the episodes were frequent, violent and potentially dangerous to his wife. He had had 40 hours sleep deprivation previously. A diagnosis of sleepwalking (somnambulism) was made. Sleep deprivation and irregular hours were the main triggers of recurrence of sleepwalking in this patient. The PSG was also important to exclude the presence of concurrent sleep disorders such as sleep apnea and periodic limb movement disorder (PLMD), as both conditions can precipitate sleepwalking events by producing sleep instability secondary to arousals.
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