Choking in the Night Due to NFLE Seizures in a Patient with Comorbid OSA

Name: Work Video:
Duration: 3 min 30 s
Michele Terzaghi; Ivana Sartori; Riccardo Cremascoli; Valter Rustioni; Raffaele Manni
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421, 524, 957, 960, 972, 1061, 1180, 1209, 1307, 1326, 1459], 'well': [173], 'apnea': [176, 319, 1182, 1461, 1580, 1633], '(OSA).': [177, 320], 'We': [178, 218], 'describe': [179, 365, 551, 741], 'case': [181, 367, 1223, 1481], 'an': [183, 447, 827, 867, 1255, 1380, 1419], 'overweight': [184, 1256], 'man,': [185], 'referred': [186, 373, 409], 'us': [188, 375, 1297], 'suspected': [190], 'reporting': [193, 1191], 'awakenings': [194], 'accompanied': [197, 228, 287, 518], 'by': [198, 229, 240, 288, 463, 519, 664, 712, 1250, 1260, 1287, 1572], 'feeling,': [203], 'which': [204], 'proved': [205], 'be,': [207], 'after': [208, 791], 'investigation,': [209], 'seizures': [211, 275, 537, 1309, 1384, 1531], 'patient': [214, 278, 370, 395, 472, 505, 544, 695, 735, 955, 991, 1025, 1074, 1262, 1312], 'comorbid': [216, 280, 1316], 'OSA.': [217, 281], 'underline': [219], 'that': [220, 470, 962], 'or': [222, 799, 1346], 'on': [224, 382, 391, 685, 1077, 1195], 'awakening,': [225, 1196], 'especially': [226, 1273], 'when': [227, 539, 1072], 'abnormal': [230, 297, 520, 1197], 'motor-behavioral': [231, 1266], 'manifestations,': [232], 'should': [233], 'interpreted': [235, 302, 971], 'caution.': [237], 'Careful': [238], 'investigation': [239], 'means': [241, 665], 'video-polysomnography': [243, 641], 'is': [244, 1289, 1322, 1333, 1353, 1408], 'warranted': [245, 1290], 'selected': [247], 'cases,': [248], 'including': [249, 650], 'patients': [250, 1190], 'strong': [253], 'clinical': [254, 377, 417, 946, 1233, 1511], 'suspicion': [255, 378, 418], 'apnea.Citation:Terzaghi': [258], 'M,': [259, 1450, 1475, 1527, 1549, 1551], 'Sartori': [260], 'I,': [261], 'Cremascoli': [262], 'R,': [263, 1433], 'Rustioni': [264], 'V,': [265], 'Manni': [266, 1432], 'R.': [267], 'Choking': [268, 1206], 'night': [271, 500, 503, 512, 1208], 'J': [282, 1619], 'Clin': [283], 'Med': [285], '2014;10(10):1149-1152.INTRODUCTIONAwakenings': [286], 'associated': [295], 'motor': [298, 521, 1198, 1414, 1536], 'activity': [299, 1199], 'paroxysmal': [304, 890, 973, 1011, 1039, 1069, 1126, 1535], 'arousals': [305, 687, 974], 'kind': [308], 'manifested': [309], 'The': [321, 453, 575, 882, 1055, 1068, 1336, 1423], 'differential': [322], 'diagnosis': [323, 1227, 1319, 1641], 'between': [324, 1436], 'challenging,': [330], 'overlapping': [332, 359], 'features': [333, 360, 1060], 'result': [335], 'being': [338], 'misdiagnosed': [339, 1458], 'OSA.1,2': [341], 'In': [342], 'particular,': [343], 'sudden': [344], 'awakening': [345, 392], 'excessive': [351, 565, 1203], 'daytime': [352, 566, 1204], 'sleepiness': [353, 567], 'have': [354, 1375, 1425], 'been': [355, 1186, 1217, 1376], 'found': [356], 'OSA.2We': [364], 'who': [371, 467], 'was': [372, 396, 408, 461, 534, 545, 557, 561, 568, 581, 662, 729, 736, 992, 995, 1017, 1021, 1075, 1098, 1228, 1417], 'based': [381], 'reported': [383, 423, 469, 506, 569, 721, 1187, 1218, 1301, 1377], 'episodes': [384, 434, 541, 683, 951, 987, 1040, 1056, 1304], 'sleep.This': [394], 'ultimately': [397], 'diagnosed': [398], 'co-morbid': [402], 'OSA.REPORT': [403], 'OF': [404], 'CASEA': [405], '33-year-old': [406], 'man': [407], 'our': [411], 'medicine': [413], 'outpatient': [414], 'unit': [415], 'OSA,': [420], 'he': [422, 715, 751], 'history': [425, 580], 'snoring': [427, 456, 779, 805, 862, 1049, 1246], 'and,': [428, 538], 'since': [429, 982, 1231], 'few': [431, 494], 'months,': [432], 'choking,': [438, 756], 'sometimes': [439, 474], 'sore': [442], 'burning': [444], 'throat': [445, 704, 1370], 'urge': [448], 'clear': [450], 'throat.': [452], 'occurrence': [454, 887, 1124], 'apneas': [458, 813, 1248], 'during': [459, 731, 789, 806, 817, 853, 1030, 1064, 1090, 1200], 'confirmed': [462], "patient's": [465, 559, 576], 'wife,': [466], 'also': [468], 'would': [473], 'abruptly': [475], 'sit': [476], 'up': [477, 698], 'bed,': [479], 'for': [481, 488, 583, 708, 1357, 1605, 1698, 1708], 'air,': [482], 'crying': [483, 706], 'out': [484, 707, 1000], 'looking': [486], 'around': [487], 'help.These': [489], 'events,': [490, 733], 'lasting': [491], 'just': [492], 'seconds,': [495], 'occurred': [496, 988], '4-5': [497], 'times': [498], 'per': [499, 513], 'almost': [501], 'every': [502], '(the': [504], 'maximum': [508], 'one': [510, 983], 'seizure-free': [511], 'week).': [514], 'They': [515], 'were': [516, 598, 692, 970], 'not': [517, 737, 759, 795, 1418], 'manifestations': [522, 1070, 1554], '(such': [523], 'tonic/dystonic': [525], 'posturing,': [526], 'involuntary': [527], 'movements,': [528], 'clonic': [529], 'jerks,': [530], 'pelvic': [531], 'thrusting);': [532], 'consciousness': [533, 728], 'preserved': [535, 730], 'throughout': [536, 878, 1116], 'ended,': [542], 'always': [546], 'able': [547, 738], 'remember': [549, 760], 'them': [552], 'clearly.': [553], 'No': [554], 'postictal': [555, 747], 'confusion': [556], 'reported.The': [558], 'BMI': [560], '29.7': [562], 'kg/m2;': [563], 'no': [564, 1427], '(Epworth': [570], 'Sleepiness': [571], 'Scale': [572], 'score': [573], '8).': [574], 'personal': [577], 'family': [579], 'negative': [582], 'arousal': [586, 851, 1088], 'parasomnias.': [587], 'examination,': [589], 'routine': [590], 'EEG,': [591], 'esophageal': [592], 'pH': [593], 'manometry,': [594], 'brain': [596, 1344], 'MRI': [597], 'normal.': [599], 'Oropharyngeal': [600], 'examination': [601], 'revealed': [602], 'mild': [604], 'deviation': [605], 'nasal': [608], 'septum,': [609], 'long': [611], 'uvula,': [612], 'Mallampati': [614], 'grade': [615], 'I': [616], 'presentation': [617, 1234], 'soft': [620], 'palate;': [621], "Muller's": [622], 'maneuver': [623], 'showed': [624, 775, 804, 1035, 1057], 'about': [625], '50%': [626], 'narrowing': [627], 'velopharyngeal': [630], 'opening.Video-PSG': [631], 'AnalysisBaselineThe': [632], 'patient,': [633], 'having': [634], 'given': [635], 'his': [636, 703, 761], 'informed': [637], 'consent,': [638], 'underwent': [639], 'in-lab': [640], '(video-PSG)': [642], 'full-scalp': [644], 'EEG': [645, 787, 1332, 1362], 'standard': [647], 'respiratory': [648, 783, 870, 876, 905, 910, 1108, 1114, 1141, 1146, 1238], 'monitoring': [649], 'use': [651], 'microphone': [654], 'abdominal': [656, 909, 1145], 'thoracic': [658, 904, 1140], 'strain': [659], 'gauges;': [660], 'airflow': [661], 'recorded': [663, 880, 1063, 1118], 'thermocouples': [667], 'located': [668], 'at': [669, 1207, 1478], 'mouth': [671], 'nostrils,': [673], 'SpO2': [675], 'using': [676], 'fingertip': [678], 'pulse': [679], 'oximeter.': [680], 'Two': [681], 'stereotyped': [682], 'occurring': [684, 852, 1089], 'abrupt': [686], 'slow': [689, 800], 'wave': [690], 'recorded:': [693], 'suddenly': [696], 'sat': [697], 'bed': [700, 1252, 1278], 'repeatedly': [701], 'clearing': [702], 'help.': [709], 'When': [710], 'questioned': [711], 'technician,': [714], 'appeared': [716], 'lucid': [719], 'sensations;': [725], 'however,': [726], 'although': [727], 'accurately': [740], 'what': [742], 'happened': [743], 'immediate': [746], 'state:': [748], 'fact,': [750], 'reports': [752], 'sensation': [754], 'but': [757], 'does': [758], 'rather': [762], 'dramatic': [763], 'screaming': [764], '(Videos': [765], '1': [766, 847], '2).The': [768], 'video-PSG': [769, 948, 1020, 1065, 1288], 'recording': [770, 1350], '(Figure': [771, 1041], '1,': [772, 1700, 1706, 1710], 'Video': [773, 1043], '1)': [774], 'presence': [777, 865, 1104], 'without': [780, 1066, 1274], 'any': [781, 797, 1001], 'clear-cut': [782], 'abnormalities': [784], 'while': [785, 989, 1095], 'before,': [788], 'episode': [793], 'did': [794], 'show': [796], 'epileptiform': [798, 1339], 'activities.': [801], 'Respiratory': [802], 'analysis': [803, 1280], 'NREM': [807, 856, 1093], 'REM': [809, 818, 838, 841], 'obstructive': [812], 'hypopneas': [815], 'exclusively': [816], 'sleep,': [819, 1201], 'global': [822], 'apnea-hypopnea': [823], 'index': [824, 830, 844], '(AHI)': [825], 'oxygen': [828, 842, 934, 1170], 'desaturation': [829, 843], '8/h': [832], '(corresponding': [835], 'AHI': [839], '79.2/h).Figure': [846], 'Upper': [848, 1085], 'part:': [849, 873, 1086, 1111], 'Paroxysmal': [850, 1087], 'stage': [854, 1091], '3': [855, 1092], 'sleep.': [857], 'Note': [858], 'recurrence': [860], 'otherwise': [868], 'regular': [869, 1107], 'pattern.': [871, 1109], 'Bottom': [872, 1110], 'hypnogram': [874, 1112], 'pattern': [877, 1115], 'night.': [881, 1119], 'black': [883], 'arrow': [884], 'indicates': [885], 'arousal.': [891], 'EOG1+': [892, 1128], 'EOG1-,': [893, 1129], 'electroculogram;': [894, 1130], 'MILO+': [895, 1131], 'MILO-,': [896, 1132], 'chin': [897, 1133], 'EMG;': [898, 924, 930, 1134, 1160, 1166], 'ECG1+': [899, 1135], 'ECG1-,': [900, 1136], 'electrocardiogram;': [901, 1137], 'THOR+': [902, 1138], 'THOR-,': [903, 1139], 'movements;': [906, 911, 1142, 1147], 'ABDM+': [907, 1143], 'ABDM-,': [908, 1144], 'FLOW-': [912, 1148], 'FLOW+,': [913, 1149], 'oro-nasal': [914, 1150], 'airflow;': [915, 1151], 'MIC+': [916, 1152], 'MIC-,': [917, 1153], 'snoring;': [918, 1154], 'TibR+': [919, 1155], 'TibR-,': [920, 1156], 'right': [921, 1157], 'anterior': [922, 928, 1158, 1164, 1395], 'tibialis': [923, 929, 1159, 1165], 'TibL+': [925, 1161], 'TibL-,': [926, 1162], 'left': [927, 1163], 'SpO2-': [931, 1167], 'SpO2+,': [932, 1168], 'arterial': [933, 1169], 'hemoglobin': [935, 1171], 'saturation;': [936, 1172], 'BODY+': [937, 1173], 'BODY-,': [938, 1174], 'body': [939, 1175], 'position.Download': [940, 1176], 'FigureIn': [941], 'light': [943], 'findings,': [949], 'captured': [952, 1286], '(which': [953], 'recognized': [956], 'same': [959, 1059], 'those': [961, 1062], 'had': [963], 'prompted': [964], 'him': [965], 'seek': [967], 'medical': [968], 'advice)': [969], 'within': [975], 'semiological': [977], 'spectrum': [978], 'NFLE.': [980], 'However,': [981], 'two': [986], 'snoring,': [993], 'it': [994, 1295], 'deemed': [996, 1354, 1410], 'necessary': [997], 'rule': [999], 'potential': [1002], 'role': [1003], 'disordered': [1006, 1052], 'breathing': [1007, 1053, 1373], 'triggering': [1009], 'events.': [1012, 1054], 'Therefore,': [1013], 'CPAP': [1015, 1027, 1031, 1100], 'titration': [1016], 'performed': [1018], 'repeated': [1022], 'under': [1026, 1099], 'treatment.CPAP': [1028], 'TreatmentVideo-PSG': [1029], '(7': [1032], 'cm': [1033], 'H2O)': [1034], 'persistence': [1036], '2)': [1044], 'absence': [1047], 'CPAP.': [1067], 'remitted': [1071], 'put': [1076], 'carbamazepine': [1078], '800': [1079], 'mg/day': [1080], '(single': [1081], 'bedtime': [1082], 'dose).Figure': [1083], '2': [1084], 'subject': [1097], 'treatment;': [1101], 'note': [1102], 'Black': [1120], 'arrows': [1121], 'indicate': [1122], 'arousals.': [1127], 'FigureDISCUSSIONMisdiagnosis': [1177], 'syndrome': [1183], 'has': [1184, 1215], 'previously': [1185], 'adult': [1189], 'sleepiness.2': [1205], 'major': [1211], 'manifestation': [1212], 'recently': [1216], 'child.3In': [1221], 'here': [1224], 'described,': [1225], 'particularly': [1229], 'difficult': [1230], 'consisted': [1235], 'mainly': [1236], 'symptoms': [1239, 1366], 'ictal': [1242, 1302, 1330], 'phase,': [1243], 'along': [1244], '(witnessed': [1249], 'partner)': [1253], 'man.': [1257], 'Imperfect': [1258], 'recollection': [1259], '(i.e.,': [1263], 'omission': [1264], 'events)': [1267], 'could': [1268], 'easily': [1269], 'lead': [1270], 'misdiagnosis,': [1272], 'clarification': [1275], 'partner.Objective': [1279], 'characterization': [1282], 'events': [1285], 'challenging': [1292, 1324], 'cases.': [1293, 1518], 'Indeed,': [1294], 'allowed': [1296], 'diagnose': [1299], 'breathlessness': [1306], 'OSA.Furthermore,': [1317], 'often': [1323], 'because,': [1325], 'this': [1328], 'case,': [1329], 'scalp': [1331, 1351, 1361], 'frequently': [1334], 'normal.4': [1335], 'evolution': [1337], 'discharges': [1340], 'either': [1341], 'deep': [1343], 'structures': [1345, 1347], 'tangential': [1348], 'electrodes': [1352], 'account': [1356], 'lack': [1359], 'abnormalities;': [1363], 'indeed,': [1364], 'viscerosensitive': [1365], 'like': [1367], 'laryngeal': [1368], 'disturbances': [1371], 'discomfort': [1374], 'characterize': [1379], 'insular': [1381, 1556], 'origin': [1382], 'arise': [1387], 'response': [1389], 'electrical': [1391], 'stimulation': [1392], 'part': [1396], 'insula.5,6': [1399], 'Extra-insular': [1400], 'spreading': [1401], 'epileptic': [1403], 'discharge': [1404], 'frontomesial': [1406], 'regions': [1407], 'instead': [1409], 'entrain': [1412], 'complex': [1413], 'manifestations.5DISCLOSURE': [1415], 'STATEMENTThis': [1416], 'industry': [1420], 'supported': [1421], 'study.': [1422, 1540, 1561], 'authors': [1424], 'indicated': [1426], 'financial': [1428], 'conflicts': [1429], 'interest.REFERENCES1': [1431], 'Terzaghi': [1434], 'MComorbidity': [1435], 'disorders.': [1440], 'Res;': [1442], '2010;90:171-7,': [1443], '20570109.': [1444], 'CrossrefGoogle': [1445, 1468, 1522, 1544, 1565], 'Scholar2': [1446], 'Oldani': [1447], 'A,': [1448], 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'Francione': [1528], 'Set': [1529], 'al.Insular-opercular': [1530], 'manifesting': [1532], 'sleep-related': [1534], 'behaviors:': [1537], 'stereo-EEG': [1539], 'Epilepsia;': [1541, 1562], '2011;52:1781-91,': [1542], '21883183.': [1543], 'Scholar6': [1545], 'Isnard': [1546], 'J,': [1547, 1614], 'Guenot': [1548], 'Sindou': [1550], 'Mauguire': [1552], 'FClinical': [1553], 'seizures:': [1558], 'stereo-electroencephalographic': [1560], '2004;45:1079-90,': [1563], '15329073.': [1564], 'Scholar': [1566], 'Previous': [1567], 'article': [1568, 1570], 'Next': [1569], 'FiguresReferencesRelatedDetailsCited': [1571], 'Diagnosis': [1573], 'treatment': [1575], 'comorbidityLiu': [1581], 'F': [1582], 'Wang': [1584, 1665], 'X': [1585], 'Expert': [1586], 'Review': [1587, 1610], 'Neurotherapeutics,': [1589], '10.1080/14737175.2017.1262259,': [1590], 'Vol.': [1591, 1622, 1648, 1672], '17,': [1592], 'No.': [1593, 1624, 1650, 1674], '5,': [1594, 1625], '(475-485),': [1595], 'Online': [1596, 1627, 1653, 1677], 'publication': [1597, 1628, 1654, 1678], 'date:': [1598, 1629, 1655, 1679], '4-May-2017.': [1599], 'Frontal': [1600], 'Lobe': [1601], 'Epilepsy:': [1602], 'Primer': [1604], 'Psychiatrists': [1606], 'Systematic': [1609], 'Psychiatric': [1612], 'ManifestationsGold': [1613], 'Sher': [1615], 'Y': [1616, 1666], 'Maldonado': [1618], 'Psychosomatics,': [1620], '10.1016/j.psym.2016.05.005,': [1621], '57,': [1623], '(445-464),': [1626], '1-Sep-2016.': [1630], 'Obstructive': [1631], 'drug-resistant': [1635], 'epilepsy:': [1636], 'significant': [1638], 'comorbidity': [1639], 'warranting': [1640], 'treatmentDinkelacker': [1643], 'V': [1644], 'Revue': [1645], 'Neurologique,': [1646], '10.1016/j.neurol.2016.03.007,': [1647], '172,': [1649], '6-7,': [1651], '(361-370),': [1652], '1-Jun-2016.': [1656], 'Association': [1657], 'Between': [1658], 'Benzodiazepine': [1659], 'Use': [1660], 'OccurrenceHarnod': [1663], 'T,': [1664], 'Kao': [1668], 'C': [1669], 'Medicine,': [1670], 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