Sleepwalking in children and adolescents

Sleepwalking or somnambulism is a parasomnia characterized by complex, quasi-purposive, motor behavior in N3 sleep. Several factors including drugs, psychosocial stressors, and endocrine factors act on a background of genetic predisposition to generate this disorder. The episodes usually occur during first few cycles of non-rapid eye movement sleep and last up to 30 min. On polysomnography, they are characterized by increased delta power in temporal relation to the event and otherwise abnormally fragmented N3 sleep. Increased rate of cyclic alternating patterns is also seen. The disorder frequently coexists with psychological morbidity including externalized anxiety, aggression, panic, or phobias in adults. Other sleep disorders including night terrors and sleep disordered breathing and neurological disorders including migraine and Tourette syndrome are known to co-occur with sleepwalking. The important differential consideration is to exclude partial-onset seizures, and overnight video-electroencephalogram (EEG) monitoring or combined polysomnography with video-EEG may be very helpful in establishing the diagnosis. Sleepwalking has been cited as a defense against homicide or other crimes with reported success, but from a clinical perspective, it is difficult to establish the exact nature of the episode during which the alleged crime was committed. Management of this enigmatic entity often involves multidisciplinary care and includes drug therapy and adaptive measures to address safety of the patient and others and to improve sleep hygiene. Although there is lack of sufficient controlled evidence, the bulk of anecdotal reports support use of benzodiazepines, especially clonazepam. Also, there is limited information about some nonpharmacologic measures.