Clinical case: Ten-year-old girl with impossibility to wake up

Abstract

The impossibility and difficulty to wake up is a sign that can appear in several sleep disorders in children: Delayed Sleep-Phase Syndrome, insomnia, Restless Legs Syndrome, Inadequate Sleep Hygiene and others like neuropsychiatric sleep disorders. CLINICAL CASE Ten-year-old girl with suspected diagnosis of epilepsy with daily episodes of hypotonia, repetitive speech and impossibility to wake up. Several EEG studies and cranial NMR were normal. Treatment with Valproate was initiated without clinical changes, so the treatment was suspended and parasomnia diagnosis was given. She was referred to sleep disorders clinic because the impossibility to wake up with school absentism. Her mother reports remarkable leg movements during first part of the night. Polysomnography and Multiple Sleep Latency Test, serum iron and ferritine level and Actigraphy were requested. Polysomnography with Multiple Sleep Latency Test results were a low increase of the Leg Movements Index in both legs regarding the diagnosis of mild Restless Legs Syndrome. Narcolepsy and infantil sleep apnea disorder were rejected. Actigraphy showed signs of Delayed Sleep-Phase Syndrome. Treatment with two drops of clonazepam before going to bed, had given good results, reducing the difficulty to wake up and improving her school performance. Restless Legs Syndrome in children can give different clinical presentation, so insomnia and difficulty to wake up must be considered in differential diagnosis. Servicio de Neurofisiología Clínica, Hospital Virgen de las Nieves.