S19: The spectrum of hypermotor disorders of sleep in pediatrics

S19: The spectrum of hypermotor disorders of sleep in pediatrics
Sunday, April 29 4:10pm-5:40pm | Room 341

Chair: Rosalia Silvestri (Italy)

Sleep hypermotor epilepsy (SHE) and disorders of arousal in children
Lino Nobili (Italy)

Pediatric Narco-cataplexy: A 24-hour motor disorder
Giuseppe Plazzi (Italy)

PLMD & RLS in children: Comorbidity and treatment
Arthur Walters (USA)

Challenging diagnostic and therapeutic aspects of hypermotor behaviors in neurodevelopmental disorders
Osman Ipsiroglu (Canada)


Summary of symposium:
The spectrum of hypermotor disorders in children goes beyond what is classified by the ICSD 3 under “Sleep Related Motor Disorders”, to include specific features of children arousal parasomnias of the first part of the night (DOA), sleep hypermotor epilepsy (SHE), many positive motor symptoms of pediatric cataplexy, and a panoply of hypermotor behaviors and stereotypies typical of neurodevelopmental disorders.

In young children it may be difficult to discern DOA atypical episodes from nocturnal hypermotor seizures. Both types of episodes may co-occur during the night, reflecting a common underlying alteration of the mechanism of arousal. The risk of over-diagnosing and especially over-treating children with frequent atypical DOA as attained by nocturnal seizures should be avoided with a careful omnicomprehensive diagnostic approach.

Children with narcolepsy resist sleepiness with a wide spectrum of active motor behaviors ranging from blinking, grimace, head extension and tongue protrusion, which may also constitute the early manifestations of a cataplectic attack. For this reason, the latter may often be misdiagnosed as epileptic in origin or dependent on an unknown motor disorder. Early recognition and treatment implementation of narcolepsy in children avoids long-term consequences such as school difficulties and precocious puberty.
RLS recognition in young children with reduced language skills to describe their symptoms may pose a diagnostic challenge. Often, psychomotor agitation and kicking may be the only recognizable aspects during the first years of manifesting symptoms. Nonetheless, they need to be precociously recognized and addressed in order to prevent other behavioral and neurological consequences such as ADHD, social disruptive conduct and mood instability.

On the other hand, children with neurodevelopmental disorders may sometimes resent drug treatments that could induce or aggravate sleep restlessness, whether or not the latter might be explained and recognized as RLS or periodic leg movement disorders (PLMD). An omnicomprehensive approach to daytime/nighttime disruptive behaviors in neurodevelopmentally challenged children is mandatory to assure them the benefits of the restorative function of sleep.

Learning Objectives:
Upon Completion of this CME activity, participants should be able to:
1 Recognize and differentially diagnose nocturnal hypermotor episodes as DOA, SHE or RLS
2 Recognize and classify daytime episodes of abnormal motor behavior under cataplexy, RLS or motor stereotypies within developmental disorders
3 To avoid harmful or inappropriate treatment of hypermotor behaviors by choosing the right therapeutic approach in accordance with a correct diagnosis

Target Audience:
Expert sleep clinicians, pediatricians, pediatric neurologists and psychiatrists, epileptologists, movement disorder specialists, sleep technicians and nurses covering pediatric wards