La diagnosi differenziale degli episodi parossistici notturni in una popolazione pediatrica con Sindrome in attenzione/iperattività (ADHD) (Differential diagnosis of nocturnal paroxysmal episodes in a sample of children with inattention/hyperactivity disorder)

Over 33 ADHD children referred to the Sleep Medicine Center by Pediatric Neurology and Psychiatry because of reported sleep disorders; 16 patients (15 M 1 F, mean age 8-12, range 4-13) presented with a total of 85 episodes of uncertain classification. Video-polisomnography (PSG) included besides standard sleep parameters bipolar EEG monitoring (10-20 system) that proved crucial for the interpretation of paroxysmal episodes. Three patients, 2 of which had centro-temporal interictal spikes associated to occipital abnormalities in 1 case, 1 with left frontal abnormalities, showed a total of 11 nocturnal hypermotor seizures (6 paroxysmal arousals). They had focal interictal epileptic discharges (IEDs) (28.1% centro-temporal spikes; 12.5% frontal spikes; 9.3% temporo-occipital spikes; 3.1% generalized Sharp-waves). Disorders of arosaul (DOA) were highly represented and often associated with seizures and/or IEDs. Sleep related movement disorders (SRMD) as sleep related rhythmic movement disorder (SRRMD), periodic leg movement disorder (PLMD), restless leg syndrome (RLS) posed some problems with differential diagnosis of paroxysmal arousals.nocturnal seizures and co-morbid tic disorder. Video-PSG proved crucial for the final classification of most episodes.