Clinical commentary with video sequences
Epileptic Disord 2010; 12 (2): 136-7
Nocturnal groaning (catathrenia) and epilepsy
Jan Zinke, Sven Rupprecht, Matthias Schwab, Georg Hagemann Hans Berger Clinic for Neurology, University Hospital Jena, Germany Received March 2, 2010; Accepted April 29, 2010
ABSTRACT – We report the case of a patient with idiopathic generalized epilepsy who ten years after the onset of his epilepsy also developed recurring nocturnal paroxysmal episodes reminiscent of his seizure semiology. Video monitoring and polysomnography revealed episodes of nocturnal groaning. Escalation of antiepileptic treatment was avoided. [Published with video sequences] Key words: differential diagnosis, epilepsy, parasomnia, nocturnal groaning
A 22-year-old male suffering from revealed REM-associated episodes seizures was treated with a daily dose of nocturnal groaning without any of 1,500 mg valproate. The seizures further abnormalities (figure 1; see started at the age of 11 years and video sequence). initially were characterized by staring, Nocturnal groaning, or catathrenia, is a hand movements, and impaired rare condition classified as parasomnia consciousness which occurred once (AASM, 2005; Vetrugno et al.,2001) a week during daytime. Additionally, which does not usually require the family reported nocturnal episodes treatment. Therefore, no change of with groaning, more violent jerking of treatment was necessary for this patient. arms and legs, loss of consciousness, Catathrenia has not previously been and enuresis which were considered to reported to be associated with epi- be generalised seizures. Repeated lepsy and it is unknown whether interictal EEGs showed only general- there is any relationship between ised slowing without epileptiform these entities. Therefore, for the time activity or focal abnormalities. He being, catathrenia should be consid- was clinically diagnosed with idio- ered as a differential diagnosis of pathic generalised epilepsy and after nocturnal seizures. Video monitoring treatment the frequency and severity or polysomnography in patients with of his seizures abated with only a few any suspicion of a change in semiol- ogy or newly encountered strange generalised nocturnal seizures being nocturnal episodes may be warranted witnessed in recent years. in order to guide or prevent additional o:10.1684/epd.2010.0317 doi: On admission to our unit, his parents therapy which may be potentially reported recurring episodes, which Correspondence: harmful or ineffective. □ G. Hagemann sounded like earlier seizures, coming Hans Berger Clinic for Neurology, from the patient’s bedroom. Upon Friedrich-Schiller-University, entering the bedroom, they found their Erlanger Alle 101, Disclosure. 07740 Jena, Germany son sleeping normally without any None of the authors has any conflict of interest
136 Epileptic Disord Vol. 12, No. 2, June 2010 Catathrenia in epilepsy
EOG R EOG L F3:A1 F4:A1 C3:A1 C4:A2 EMG ECG PLM L PLM R Snore Flow Effort th Effort a SpO 2 Pulse Pos
Figure 1. Polysomnography shows REM-associated episodes of nocturnal groaning without EEG abnormalities.
References Legend for video sequence Polysomnographic recording showing an episode of American Academy of Sleep Medicine. The International nocturnal groaning. REM sleep was followed by arousal Classification of Sleep Disorders, Diagnostic and Coding Manual. with deep inspiration and prolonged expiration associ- Westchester (IL): AASM, 2005 : 165-7. ated with the typical groaning. Channels from top to Vetrugno R, Provini F, Plazzi G, Vignatelli L, Lugaresi E, bottom: electrooculogram (2 channels), electroence- Montagna P. Catathrenia (nocturnal groaning): a new type of phalogram (4 channels), submental electromyogram, parasomnia. Neurology 2001; 56: 681-3. electrocardiogram, tibial electromyogram (2 channels), microphone, oronasal flow, thoracic and abdominal movements, oxygen saturation, pulse, body position.
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