title: Prolonged confusion with nocturnal wandering arising from NREM and REM sleep: a case report.
abstract: A 51-year-old man with Machado-Joseph disease had a 3-year history of prolonged confusion following nightly nocturnal wandering. Polysomnography with videotape monitoring revealed 19- to 120-minute sleepwalking episodes emerging from non-rapid eye movement (NREM) sleep and occasionally from rapid eye movement (REM) sleep, followed by 22-47 minutes of prolonged confusion and disorientation. The patient also had a periodic limb movement disorder and obstructive sleep apnea syndrome. Excessive daytime sleepiness was evident by results from the Epworth Sleepiness Scale and Multiple Sleep Latency Test. A sleep-deprived electroencephalogram (EEG) and a polysomnogram with an expanded EEG montage before and during these episodes revealed no epileptiform activity. A contrast-enhanced brain magnetic resonance imaging (MRI) scan demonstrated findings consistent only with Machado-Joseph disease. The patient improved with a combination of temazepam and carbidopa-levodopa.
authors.affiliation: Stanford University Sleep Disorders Clinic and Research Center, California 94305-5547, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Kushida
authors.forename: A A
authors.initials: AA
authors.lastname: Clerk
authors.forename: C M
authors.initials: CM
authors.lastname: Kirsch
authors.forename: J R
authors.initials: JR
authors.lastname: Hotson
authors.forename: C
authors.initials: C
authors.lastname: Guilleminault
mesh_terms: D002531:Cerebellum / Q000503:physiopathology; D003221:Confusion / Q000150:complications*; D004569:Electroencephalography; D006801:Humans; D017827:Machado-Joseph Disease / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011149:Pons / Q000503:physiopathology; D012148:Restless Legs Syndrome / Q000150:complications; D012891:Sleep Apnea Syndromes / Q000150:complications; D012892:Sleep Deprivation; D012894:Sleep Stages; D012895:Sleep, REM; D013009:Somnambulism / Q000150:complications*