Psychogenic events also must be included in the differential diagnosis of nocturnal events(see Table: Differential Diagnosis of Nocturnal Events). Among these are dissociative disorders. These disorders are relatively rare and may present initially as only nocturnal events.56 These fugue states may last hours, with loss of identity and memory. Patients usually have some diurnal symptoms and may have a history of physical or sexual abuse. They can occur in association with post-traumatic stress disorder.57
During polysomnographic monitoring, patients with dissociative disorders frequently demonstrate wakefulness before the onset of the spells.58 Simultaneous time-synchronized video monitoring is required to correlate the behavior with the electrographic data.
Conversion disorders also present as nocturnal events. Patients have significant underlying stressors or conflicts, which initiate or exacerbate the episodes.56 They may also have models to mimic epileptic spells. Although these events are unintentional, they have a clear impact on the patient's ability to function.56
Most patients with nocturnal events and conversion disorders have arousals before their events. They may or may not have memory for the events.
Reviewed and revised April 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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