One rare side effect of zolpidem--sleepwalking: a case report

Zolpidem is an imidazopyridine agent indicated for the short-term treatment of insomnia. Sleepwalking is a rare side effect of zolpidem. A review of the literature produced only 2 cases. We report a case of a male rehabilitation inpatient in his mid fifties with a history of alcoholism and traumatic brain injury who had undergone a right hip hemiarthroplasty. He had no history of somnambulism or insomnia but walked in his sleep on 2 nonconsecutive nights after taking zolpidem. He had exhibited no such behavior before taking zolpidem, on the intervening night that was he was not given medication, and after the medication was discontinued. We conclude that zolpidem can cause sleepwalking, and patients who have suffered a brain injury may be more susceptible to this side effect. Here we describe the clinical presentation and review the relevant literature on zolpidem and sleepwalking.     

SOMNAMBULISM IN CHILDHOOD-PREVALENCE, COURSE AND BEHAVIORAL CORRELATIONS

ABSTRACT. prevalence, course and behavioral correlations. Acta Paediatr Scand, 71: 495, 1982.–The occurrence and course of somnambulism and its correlations with behavioral variables have been investigated annually from 6 to 16 years of age in a sample recruited by random means. The prevalence was highest at 11-12 years. No sex difference was found. Apart from sporadic occurrences, the longitudinal data reveal a group of children for whom somnambulism is rather persistent. But even in this group the somnambulism is usually unrelated to other sleep disturbances (apart from "bad" dreams), deviant behavior or known environmental factors. These children have more inhibited aggression and a more developed mental defence against anxiety as determined by Rorschach tests. At school they appear to be more popular than other children.     

Paroxysmal motor disorders of sleep: the clinical spectrum and differentiation from epilepsy

The diagnosis of paroxysmal events in sleep represents a significant challenge for the clinician, with the distinction of nocturnal epilepsy from nonepileptic sleep disorders often the primary concern. Diagnostic error or uncertainty is not uncommon in this situation, particularly with respect to nocturnal frontal lobe epilepsy (NFLE), which has a variable and often unusual presentation. Such errors can be minimized if the range of nonepileptic disorders with motor activity in sleep is fully appreciated. Here we review these disorders, before discussing the important clinical and electrographic features that allow their accurate differentiation from seizures. Particular emphasis is placed on the differentiation of nocturnal frontal lobe epilepsy from non-rapid eye movement (NREM) arousal disorders and other parasomnias. The value of recording episodes with video EEG polysomnography is discussed.     

From burlesque to horror: a century of sleepwalking on the silver screen

BackgroundLong before being described as a disorder, sleepwalking was considered as a mysterious phenomenon inspiring artwork. From the early beginning of cinema, sleepwalkers were shown to populations, playing a crucial role in storytelling and collective knowledge.ObjectiveWe characterized how sleepwalking has been portrayed in a large number of movies from the origins of cinema to recent years.MethodsMovies containing the words “sleepwalking” or “somnambulism” were searched for in International Movie Databases. Types of movies, sleepwalking characters, postures and behaviors during episodes, triggers, and suggested treatments were collected.ResultsProduction of 87 movies and 22 cartoons portraying sleepwalkers was clustered around two peaks, in the 1910s and 2010s. Comedies predominated before 1960, and thriller/horror movies as a dominant genre after 1960. In contrast with real-life sleepwalking epidemiology, sleepwalkers are more often portrayed as women than men (and often wearing a transparent white nightgown), as adults more than children on-screen, and 23% suffered psychiatric comorbidities. The unrealistic posture of outstretched arms and eyes closed was found in 20% of movies and 79% of cartoons. Night terrors, sexsomnias (kissing, having sex, initiated pregnancy), sleep-related eating and sleep driving were also featured. Homicides and falls while sleepwalking were recurrent fear-inducing topics. The first sleep EEG was featured in a sleepwalking movie in 1985, and a sleep specialist gave his first advice in 1997.DiscussionThe representation of sleepwalking on the screen seems to have evolved from popular, unrealistic stereotypes of somnambulism towards a medical condition, paralleling the development of sleep medicine.     

The Arousal Disorders Questionnaire: a new and effective screening tool for confusional arousals,Sleepwalking and Sleep Terrors in epilepsy and sleep disorders units

BackgroundArousal Disorders (DoA) include Confusional Arousals, Sleepwalking and Sleep Terrors. DoA diagnosis is mainly clinical but no validated questionnaires exist for DoA screening according to the criteria of the International Classification of Sleep Disorders, Third Edition. Recently our group proposed the Arousal Disorders Questionnaire (ADQ) as a new diagnostic tool for DoA diagnosis. The objective of this study was to evaluate the diagnostic accuracy of the ADQ in a sleep and epilepsy center.MethodsOne interviewer blinded to clinical and video-polysomnographic (VPSG) data administered the ADQ to 150 patients consecutively admitted to our Sleep and Epilepsy Centers for a follow-up visit. The final diagnosis, according to VPSG recordings of at least one major episode, classified patients either with DoA (DoA group) or with other sleep-related motor behaviors confounding for DoA (nDoA group).Results47 patients (31%) composed the DoA group; 56 patients with REM sleep behavior disorder, 39 with sleep-hypermotor epilepsy, six with night eating syndrome, and two with drug-induced DoA composed the nDoA group. The ADQ had a sensitivity of 72% (95% CI: 60–82) and a specificity of 96% (95% CI: 89–98) for DoA diagnosis; excluding the items regarding consciousness and episode recall, sensitivity was 83% (95% CI: 71–90) and specificity 93% (95% CI: 86–97).ConclusionsThe ADQ showed good accuracy in screening patients with DoA in a sleep and epilepsy center setting. Diagnostic criteria related to cognition and episode recall reduced ADQ sensitivity, therefore a better definition of these criteria is required, especially in adults.     

La Société Médico-Psychologique face aux névroses extraordinaires (1857–1860)

ObjectivesThe aim of this article is to contextualize the debate on extraordinary nevroses which has been held at the Société Médico-Psychologique in the mid of the nineteenth century.Materials and methodsAn analysis of the sessions’ records was conducted which allowed to identify some subjects and to expose them by depending on their content.ResultsThe Société Médico-Psychologique experienced great discussions and debates that have marked its history. Among these discussions, that the extraordinary neuroses has so far received little comments and perspectives. What the members of the young Society, founded in 1852, had chosen to debate did not fail the “wonderful” feature accompanying especially the most surprising phenomena of magnetism and somnambulism, natural or spontaneous, the most controversial also. The question that arises is why the attention of members of the Société Médico-Psychologique was drawn phenomena out of the ordinary clinic ? The introduction, done by the doctor Laurent Cerise (1809–1869), of the debate on extraordinary neuroses is actually corresponding to the reintroduction of the theme of magnetic somnambulism and its therapeutic use, even though its exclusion from science and official medicine was delivered in 1842.ConclusionsThe discussion of extraordinary neuroses has been one of those strong moments of confrontation between different conceptions of nervous pathology still surrounded by uncertainty and difficulty extracted from the sphere of magnetism and somnambulism. “Extraordinary” meant both little known, spectacular, restive medicine, but equally a reported beyond the usual categories of perception and intelligence, extraordinary performance in body and spirit recognized for as long associated with certain neuroses and magnetic somnambulism. That's why, it was dangerous to be able to reflect on the extraordinary neurosis without falling into the wonderful of magnetism. However, the Laurent Cerise's project, the initiator of the discussion of extraordinary neuroses, has pointed out that we can make more rational use of medical and especially more magnetic report in the therapeutics of the toughest and most neuroses rebels in his own words. He also gave an opportunity for some to argue that if the neuroses are physiological conditions, the influence of the moral on their occurrence and their work is not negligible (mourning, intra-family violence, sexuality). Finally, cases are exploited sufficiently shown that the “self” can be divided and neurotic subjects have a dual existence or double existence.     

Diagnostic accuracy of a structured interview for nocturnal frontal lobe epilepsy (SINFLE): a proposal for developing diagnostic criteria

Objectives

To measure the accuracy of anamnestic features collected during clinical history for the diagnosis of nocturnal frontal lobe epilepsy (NFLE).

Methods

A case-control diagnostic study. Participants included a case group of people with ascertained target disease (NFLE group) and a control group of people with sleep disorders potentially confounding for NFLS (NOT-NFLE group), defined by means of a consensus procedure among experts (panel diagnosis as reference standard). Two major clinical patterns defining the semeiology of the epileptic event (i.e. dystonic, DP, and/or hyperkinetic pattern, HP), and 13 additional minor features were identified, formulated as questions, and telephonically administered to NFLE and NOT-NFLE groups by a trained doctor blinded to the final diagnosis. The diagnostic accuracy of each characteristic was tested against the reference standard.

Results

Out of 262 selected subjects, 101 were recruited; 42 were NFLE and 59 NOT-NFLE. A positive history of DP or HP had a sensitivity of 59.5% and a specificity of 91.5%, irrespective of the other minor anamnestic features. The anamnestic model improved, with a sensitivity of 59.5% and specificity of 96.6%, if at least one of the following four minor anamnestic features was added: (a) duration less than two minutes, (b) unstructured vocalization during the episode, (c) experience of an aura preceding the motor attack, and (d) a history of tonic-clonic seizures during sleep.

Conclusions

The present study disclosed two major anamnestic patterns and four minor features that we called SINFLE, with unsatisfactory sensitivity but high specificity. These patterns could be the basis for developing future NFLE diagnostic criteria and to quantify the diagnostic accuracy of elements usually collected in the clinical history.     

Treatments for somnambulism in adults: Assessing the evidence

Somnambulism, or sleepwalking, is a parasomnia of non-rapid eye movement (NREM) sleep where movement behaviours usually confined to wakefulness are displayed during sleep. Generally, if sleepwalking is causing distress or danger in spite of safety measures, medical or psychological treatment is indicated. Clinicians will need to assess the evidence for treatment options. MEDLINE, EMBASE, PsycINFO and the Ovid Evidence–Based Medicine Reviews (EBM) multifile databases were searched. No properly powered rigorous controlled trials were found for treatment of sleepwalking in adults. Seven reports described small trials with some kind of control arm, or retrospective case series which included 30 or more patients. With no high quality evidence to underpin recommendations for treatments of somnambulism, full discussion with patients is advised. Adequately powered, well-designed clinical trials are now needed, and multi-centre collaborations may be required to obtain the sample sizes required.     

Gray matter abnormalities of the dorsal posterior cingulate in sleep walking

ObjectiveThis study aimed to determine whether voxel-based analysis of T1 weighted magnetic resonance imaging (MRI) and diffusion tensor imaging is able to detect alterations of gray and white matter morphometry as well as measures of mean diffusivity and fractional anisotropy in patients with non-rapid eye movement parasomnia.Methods3 Tesla MRI was performed in 14 drug-free, polysomnography-confirmed adult patients with non-rapid eye movement parasomnia (age: 29 ± 4.2 years; disease duration 19.2 ± 7.7 years) and 14 healthy subjects, matched for age and gender. Statistical parametric mapping was applied to objectively identify focal changes of MRI parameters throughout the entire brain volume.ResultsStatistical parametric mapping localized significant decreases of gray matter volume in the left dorsal posterior cingulate cortex (BA23) and posterior midcingulate cortex (BA24) in patients with non-rapid eye movement parasomnias compared to the control group (p < 0.001, corrected for multiple comparisons). No significant differences of mean diffusivity and fractional anisotropy measures were found between the non-rapid eye movement parasomnia group and the healthy control group.ConclusionsRecently, the simultaneous co-existence of arousal or wakefulness originating from the motor and cingulate cortices and persistent sleep in associative cortical regions was suggested as a functional framework of somnambulism. Gray matter volume decline in the dorsal posterior and posterior midcingulate cortex reported in this study might represent the neuroanatomical substrate for this condition.