Posted by Lewis on April 09, 2003 at 07:40:18:

In Reply to: exam posted by sleepdoc on April 08, 2003 at 20:55:36:

DDx:
1. Sleep starts
2. fragmentary myoclonus
3. Periodic limb movement disorder
4. Sleep-related epilepsy
5. Paroxysmal nocturnal dystonia
6. REM-behavior disorder
7. Neurologic disorders such as the Parkinsonisms
8. Nocturnal leg cramps
9. Obstructive sleep apnea with resultant sleep fragmentation and movements during arousals

RX:
First, obtain a much more thorough sleep history (from pt and bed partner), medical history and medication list. I am particularly interested whether he has any abnl movements during the day such as RLS sxs, dystonias, tremors or a seizure disorder - as well as all of the other usual sleep and medical questions.
Second, would perform a diagnostic PSG with an extended EEG montage (12-16 leads), video recording of PSG, and also extra limb leads.

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