Perfect Periodicity: To Be Or Not To Be Periodic Leg Movements.

Journal of Clinical Sleep Medicine, Vol. 12, No. 3, 2016 A 3-year-old girl with history of severe developmental delay, intractable seizures on multiple anti-epileptic medications (clobazam, rufinamide, benzodiazepines, and cannabidiol oil), and gastrostomy tube placement for feeding difficulties, was referred for a full-night video electroencephalogram (EEG) and polysomnogram (PSG) study. The full-night video EEG/ PSG study was considered because of nocturnal oxygen desaturations at home with concerns for possible nocturnal seizures and/or sleep-related respiratory events. Her physical examination was significant for hypertrophy of the inferior nasal turbinates and a modified Mallampati score of 3. Her neurological examination was significant for being nonverbal, opening her eyes intermittently without tracking, and having diffuse hypotonia without purposeful movements. Video EEG showed generalized slowing of background activity with burst suppression pattern but without seizures. Diagnostic PSG showed severe sleep apnea with an apnea-hypopnea index (AHI) of 23.3 events/h (including an obstructive SLEEP MEDICINE PEARLS

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