title: A neurological cause of recurrent choking during sleep.
abstract: We describe a case of nocturnal choking episodes caused by insular seizures. Recurrent choking spells from sleep showed no response to treatment for sleep apnea or gastroesophageal reflux. Laryngoscopy revealed no abnormalities. Although continuous EEG monitoring during events was normal, ictal SPECT imaging showed increased radiotracer uptake in the left insular region, an area involved in sensation of the upper gastrointestinal tract. The episodes remitted after initiation of an antiepileptic drug. Obstructive sleep apnea is the most common cause for presentation to a sleep center, but seizures should remain in the differential diagnosis of nocturnal choking episodes.
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA. kathryn.davis@uphs.upenn.edu
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Davis
authors.forename: Charles
authors.initials: C
authors.lastname: Cantor
authors.forename: Douglas
authors.initials: D
authors.lastname: Maus
authors.forename: Susan T
authors.initials: ST
authors.lastname: Herman
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000188:drug therapy / Q000209:etiology*; D000927:Anticonvulsants / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D006801:Humans; D008297:Male; D017286:Polysomnography; D012640:Seizures / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000927:Anticonvulsants