A 5-year-old boy occasionally gets out of bed 1 to 2 hours after falling asleep, walks around the house with his eyes open, is unresponsive to his parents, and has no memory of the event the next morning. Episodes are infrequent and he has never been injured. His parents ask what should be done. The most appropriate advice is:

• A Order an overnight EEG to exclude epilepsy
• B Reassure the parents, ensure bedroom safety measures, and ensure adequate sleep ✓
• C Fully awaken the child during each episode so he remembers it
• D Start nightly clonazepam until adolescence

Explanation

Sleepwalking is a benign NREM arousal parasomnia occurring in slow wave sleep in the first third of the night, with amnesia for events. Management is parental reassurance, safety measures such as gates and locking windows, and attention to sleep hygiene and sufficient sleep, since sleep deprivation increases episodes. Most children outgrow it by adolescence, and medication is reserved for frequent injurious episodes. Waking the child fully is unnecessary and distressing, and interictal EEG is normal, distinguishing it from nocturnal frontal lobe seizures.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.