Repetitive sleep starts in neurologically impaired children: an unusual non-epileptic manifestation in otherwise epileptic subjects

Sleep starts, also called hypnagogic or hypnic jerks, are bilateral, someti mes asymmetric, usually single, brief body jerks that coincide with sleep o nset. We describe sleep starts occurring repetitively in three epileptic ch ildren with spastic-dystonic diplegia and mental retardation. Repetitive sl eep starts began at age 18 months in two children and at 9 months in the th ird. All three children had had feto-neonatal asphyxia; two presented with spastic and one with dystonic tetraparesis. One had West syndrome and two h ad partial motor seizures in the first year of life. Seizures were controll ed in all three patients by antiepileptic drug therapy. Video/EEG recording s of all the children during the afternoon nap revealed clusters of sleep s tarts during the transition between wakefulness and sleep. Cluster lasted 4 -15 min and comprised from twenty to twenty-nine contractions. The EEC coun terpart of the event sometimes showed an arousal response, at times inducin g complete awakening. Repetitive sleep starts should be recognized and clea rly differentiated from epileptic seizures, especially ii they appear in ep ileptic subjects. In neurologically compromised patients, they could repres ent an intensification of an otherwise normal event, due to the lack of str ong inhibitory influence of the pyramidal tract resulting from the pyramida l lesion.