A 64-Year-Old Man Is Brought to the Office for Evaluation

A 64-year-old man is brought to the office for evaluation of abnormal behaviors during sleep.  According to his wife, over the past 3 months the patient has had episodes of repeatedly punching at the pillow and screaming loudly while asleep.  When awakened from these episodes, he recalls a disturbing dream in which he is chased by assailants and must defend himself or escape.  The episodes usually last less than 1-2 minutes.  Vital signs are within normal limits.  General physical and mental status examinations show no abnormalities.  A formal sleep study (polysomnogram) is ordered.  Which of the following is most likely to be identified during this testing?

A) Excessive, sustained muscle tone during REM sleep
B) Focal epileptic activity originating from the temporal lobe with secondary generalization
C) Focal, sharp epileptic activity originating from the frontal lobes
D) Mixture of wake-like and sleep-like states in different cortical regions in non-REM sleep
E) Sleep latency of less than 5 minutes and multiple sleep-onset REM periods

Correct Answer:

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