Abstract
BackgroundExploding head syndrome is a rarely reported benign sensory parasomnia that may nonetheless have significant impact on patients’ quality of life and their perceived well-being. To date, the mechanisms underlying attacks, characterised by a painless perception of abrupt, loud noises at transitional sleep-wake or wake-sleep states, are by and large unclear.Methods and resultsIn order to address the current gap in the knowledge of potential underlying pathophysiology, a retrospective case-control study of polysomnographic recordings of patients presenting to a tertiary sleep disorders clinic with exploding head syndrome was conducted. Interictal (non-attack associated) electroencephalographic biomarkers were investigated by performing macrostructural and event-related dynamic spectral analyses of the whole-night EEG. In patients with exploding head syndrome, additional oscillatory activity was recorded during wakefulness and at sleep/wake periods. This activity differed in its frequency, topography and source from the alpha rhythm that it accompanied.ConclusionBased on these preliminary findings, we hypothesise that at times of sleep-wake transition in patients with exploding head syndrome, aberrant attentional processing may lead to amplification and modulation of external sensory stimuli.
Highlights
Exploding head syndrome (EHS) is an unusual paroxysmal sensory parasomnia [1], which is characterised by the painless perception of abrupt, loud noises at transitional sleep-wake or wake-sleep states [2,3]
All EHS patients demonstrated oscillatory activity during pre-sleep wake or Wakefulness After Sleep Onset (WASO) periods that was additional to the expected alpha rhythm, and which we define here as ‘‘alpha co-activation’’ (ACA) (Figure 1)
No ACA periods were present in pre-sleep wake, WASO or any other alpha rhythm periods of the matched control patients (Figure 3)
Summary
Exploding head syndrome (EHS) is an unusual paroxysmal sensory parasomnia [1], which is characterised by the painless perception of abrupt, loud noises at transitional sleep-wake or wake-sleep states [2,3]. A study of parasomnia prevalence, which applied the Munich Parasomnia Screening questionnaire to 180 healthy participants, found a lifetime prevalence of EHS of 11% [5], with a second, slightly larger and specific study of young adults yielding 18%, within which 16.5% reported experiencing recurrent episodes [6]. Building on these population-based data, Denis and colleagues recently surveyed 199 female undergraduates to find a lifetime prevalence of 37.2% (6.5% experiencing monthly episodes), with insomnia and sleep paralysis showing a significant co-association with EHS [7]. Conclusion: Based on these preliminary findings, we hypothesise that at times of sleep-wake transition in patients with exploding head syndrome, aberrant attentional processing may lead to amplification and modulation of external sensory stimuli
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