Disorders of Arousal

Sleepwalking, sleep terrors, and confusional arousals are non-REM sleep parasomnias grouped under the specific category of disorders of arousal (DOA). These conditions are characterized by incomplete arousals from deep sleep that lead to a broad variety of emotional and motor behaviors. The advent of electroencephalography (EEG) and the discovery of rapid eye movement (REM) sleep as opposed to non-REM sleep allowed researchers to consider these phenomena from a neurophysiological rather than a purely psychopathological perspective. The utilization of new neurophysiologic techniques such as high-density scalp EEG, stereo-EEG, and advanced signal analysis methods shed further light on the mechanisms underpinning DOA and supported the notion that they should be viewed within the frame of the so-called dissociate state of being as intermediate state between wake and NREM sleep. Furthermore, other important issues like the boundaries between motor-behavioral manifestations in DOA and NFLE, neurocognitive functions, the occurrence of mentation/dream imagery during episodes in DOA and DOA daytime consequences, and treatment are still matters of debate.