Some of the more common, uncomplicated, noninjurious parasomnias, such as typical disorders of arousal, nightmares, enuresis, somniloquy, and bruxism can usually be diagnosed by clinical evaluation alone. A clinical history, neurologic exam and routine EEG obtained while the patient is awake and asleep are often sufficient to establish the diagnosis and permit the appropriate treatment of sleep related epilepsy.
Polysomnography, including video recording and additional EEG channels in an extended bilateral montage, is routinely indicated to assist with the diagnosis of paroxysmal arousals or other sleep disruptions that are thought to be seizure related when the initial clinical evaluation and results of a standard EEG are inconclusive. Polysomnography is not routinely indicated for patients with epilepsy who have no specific symptoms consistent with a sleep disorder.
Polysomnography is indicated to provide a diagnostic classification or prognosis when both of the following exist: the clinical evaluation and results of standard EEG have not demonstrated a seizure disorder; and there is a history of repeated violent or injurious episodes during sleep. Normally when polysomnography is performed for the diagnosis of parasomnias, the following measurements are obtained: sleep-scoring channels (EEG, EOG, chin EMG); EEG using an expanded bilateral montage; EMG for body movements; and audio-video recording and documented technologist observations