Parasomnia.Parasomnias are a group of disorders during sleep that are associated with brief or partial arousals but not with marked sleep disruption or impaired daytime alertness. The presenting complaint is usually related to the behavior itself. Most parasomnias are more common in children, but may persist into adulthood when their occurrence may have more pathologic significance. Behavior during these times can often lead to damage to the patient’s surroundings and injury to the patient or to others.
Parasomnias include the following conditions: confusion arousals, sleepwalking (Somnambulism), sleep terrors, REM sleep behavior disorder, sleep-related epilepsy, sleep bruxism, sleep enuresis, and miscellaneous (nocturnal headbanging, sleep talking, restless leg syndrome, periodic limb movement disorder, and nocturnal leg cramps).

Some of the more common, uncomplicated, noninjurious parasomnias, such as typical disorders of arousal, nightmares, enuresis, somniloquy, and bruxism can usually be diagnosed by clinical evaluation alone. A clinical history, neurologic exam and routine EEG obtained while the patient is awake and asleep are often sufficient to establish the diagnosis and permit the appropriate treatment of sleep related epilepsy.

Polysomnography, including video recording and additional EEG channels in an extended bilateral montage, is routinely indicated to assist with the diagnosis of paroxysmal arousals or other sleep disruptions that are thought to be seizure related when the initial clinical evaluation and results of a standard EEG are inconclusive. Polysomnography is not routinely indicated for patients with epilepsy who have no specific symptoms consistent with a sleep disorder.

Polysomnography is indicated to provide a diagnostic classification or prognosis when both of the following exist: the clinical evaluation and results of standard EEG have not demonstrated a seizure disorder; and there is a history of repeated violent or injurious episodes during sleep. Normally when polysomnography is performed for the diagnosis of parasomnias, the following measurements are obtained: sleep-scoring channels (EEG, EOG, chin EMG); EEG using an expanded bilateral montage; EMG for body movements; and audio-video recording and documented technologist observations

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