Nocturnal paroxysmal dystonia and nocturnal wandering

Abstract

Nocturnal paroxysmal dystonia (NPD) and episodic nocturnal wanderings (ENWs) are complex motor attacks arising abruptly during sleep, especially nonrapid eye movement sleep. NPD is characterized by sudden arousal followed by motor agitation with dystonic posturing, and semipurposeful activity recurring several times per night. When short-lasting, NPD may respond favorably to carbamazepine. ENWs are unusual episodes of ambulation, with unintelligible speech, screaming, and complex, often violent, behavior that responds to anticonvulsants. In both short-lasting NPD and ENWs, electroencephalography may show some evidence of epilepsy; NPD is clinically similar to the frontal lobe seizures that arise mesially or in depth. Paroxysmal arousals (PAs) are even shorter episodes of arousal or awakening during nonrapid eye movement sleep, associated with transient dystonic posturing and related to the short-lasting NPD. PAs, short-lasting NPD, and ENWs probably represent a spectrum of peculiar sleep-related epileptic seizures.