LNSLNS

We thank Dr. Riemer for his comments and the discussion of the differential diagnosis of parasomnias.

As we explained in our review article, “poor sleep” is an umbrella term for many disorders during sleep and when awake (1). Indeed, nocturnal attacks/seizures in young people with no prior health problems should prompt detailed and careful differential diagnostic evaluation. Additional symptoms, such as cognitive impairment during the day, personality changes, or daytime tiredness that would be inappropriate in someone whose sleep was subjectively good, should warrant further investigations. The patient’s age is decisive for the differential diagnostic evaluation. In young, otherwise healthy patients, epilepsies are more common; other parasomnias—for example, REM-sleep-behavior disorder (RBD) as an important differential diagnosis of nocturnal behavior is typical for older patients; young patients with RBD are rare. Distinguishing nocturnal epileptic seizures from parasomnias or otherwise disturbed sleep can be difficult. Questionnaires may provide initial indications (2).

The mentioned differential diagnoses for SHE (“sleep-related hypermotor epilepsy”—previously called „nocturnal frontal lobe epilepsy“ [NFLE] [3]) are rare, but because of their rarity and the often normal interictal EEG, they constitute an important differential diagnosis of great importance for therapy.

In conclusion, the colleague’s case report confirms the approach that sleep-related disorders need to be carefully diagnostically evaluated, by symptom complex and additional symptoms, and should not generally be treated with “sleeping pills.”

DOI: 10.3238/arztebl.2020.0118b

On behalf of the authors
PD Dr. med. Jan Rémi
Neurologische Klinik und Poliklinik, LMU München
jan.remi@med.lmu.de

Conflict of interest statement
PD Rémi received fees for advisory board activities as well as lecture fees from Vanda. He received lecture fees from Vanda and Bioproject. For carrying out clinical trials on a contract basis, he received funding from Kappa Saute.

1.
Rémi J, Pollmächer T, Spiegelhalder K, Trenkwalder C, Young P: Sleep-related disorders in neurology and psychiatry. Dtsch Arztebl Int 2019; 116: 681–8 VOLLTEXT
2.
Derry CP, Davey M, Johns M, et al.: Distinguishing sleep disorders from seizures: diagnosing bumps in the night. Arch Neurol 2006; 63: 705–9 CrossRef MEDLINE
3.
Tinuper P, Bisulli F, Cross JH, et al.: Definition and diagnostic criteria of sleep-related hypermotor epilepsy. Neurology 2016; 86: 1834–42 CrossRef MEDLINE PubMed Central
1.Rémi J, Pollmächer T, Spiegelhalder K, Trenkwalder C, Young P: Sleep-related disorders in neurology and psychiatry. Dtsch Arztebl Int 2019; 116: 681–8 VOLLTEXT
2.Derry CP, Davey M, Johns M, et al.: Distinguishing sleep disorders from seizures: diagnosing bumps in the night. Arch Neurol 2006; 63: 705–9 CrossRef MEDLINE
3.Tinuper P, Bisulli F, Cross JH, et al.: Definition and diagnostic criteria of sleep-related hypermotor epilepsy. Neurology 2016; 86: 1834–42 CrossRef MEDLINE PubMed Central

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