Confusional arousal episodes, a milder form of Disorders of Arousal (DOA), reveal intriguing brain activity patterns. In a study involving a 12-year-old child with sleepwalking, 20 episodes were analyzed using high-density EEG. Findings showed a significant increase in slow wave activity (SWA) across theta, alpha, beta, and gamma frequencies during episodes compared to baseline sleep. Notably, connectivity analysis indicated enhanced communication between brain regions, particularly from the prefrontal cortex and temporal lobe, suggesting a unique brain state associated with night terrors and somnambulism.
Disorders of Arousal (DOA), traditionally considered unconscious states, may involve conscious experiences more often than previously thought. A narrative review of the literature finds that about 50-60% of adults recall conscious experiences immediately after a DOA episode, while children have a lower recall rate (under 30% when interviewed retrospectively). Patient reports range from brief scenic fragments to elaborate scenarios with plot development, often involving negative emotions and misfortunes, and there is considerable correspondence between subjective experiences and observed behaviors. In many cases, patients appear to enact their dreams, entering a hallucinatory state where internally generated images overlay external percepts. The review discusses implications for clinical management, research, and legal considerations regarding nocturnal violence.