Evidence of dissociated arousal states during NREM parasomnia from an intracerebral neurophysiological study.
OBJECTIVE
Arousal parasomnias are expressions of sleep/ wake state dissociations in which wakefulness and NREM sleep seem to coexist. We describe the results of a neurophysiological (intracerebral EEG) investigation that captured an episode of confusional arousal.


METHODS
Observational analysis.


METHODS
Tertiary sleep center.


METHODS
A 20-year-old male with refractory focal epilepsy.


RESULTS
The intracerebral EEG findings documented the presence of a local arousal of the motor and cingulate cortices associated with increased delta activity in the frontoparietal associative cortices; these findings were noted preceding the onset and persisting throughout the episode.


CONCLUSIONS
The presence of dissociated sleep/wake states in confusional arousals is the expression not of a global phenomenon, but rather of the coexistence of different local states of being: arousal of the motor and cingulate cortices and inhibition of the associative ones. Whether this is an exclusive feature of NREM parasomnias, or a common substrate on which other triggering elements act, needs to be clarified.
Terzaghi
Michele
M
Sleep Medicine and Epilepsy Unit, IRCCS "C. Mondino Institute of Neurology" Foundation, Pavia, Italy. michele.terzaghi@mondino.it
Sartori
Ivana
I
Tassi
Laura
L
Didato
Giuseppe
G
Rustioni
Valter
V
LoRusso
Giorgio
G
Manni
Raffaele
R
Nobili
Lino
L
D001143:Arousal / Q000502:physiology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D004213:Dissociative Disorders / Q000503:physiopathology*; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000503:physiopathology* / Q000601:surgery; D005625:Frontal Lobe / Q000503:physiopathology; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology; D009415:Nerve Net / Q000503:physiopathology; D020447:Parasomnias / Q000503:physiopathology*; D010296:Parietal Lobe / Q000503:physiopathology; D012815:Signal Processing, Computer-Assisted; D012894:Sleep Stages / Q000502:physiology*; D013009:Somnambulism / Q000503:physiopathology; D014741:Video Recording; D055815:Young Adult