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Sleepwalking and night terrors related to febrile illness.

Sleepwalking and night terrors have been defined as disorders of arousal (1 ) that occur early in the night and have their onset during stage 3 or 4 sleep (2, 3). During a sleepwalking episode, the individual seems confused, detached, and relatively unresponsive. Night terrors are more dramatic; patients manifest terror and panic, and there is extreme autonomic discharge and vocalization. In both disorders, patients are difficult to arouse, and complete amnesia or minimal recall of the episode is frequent. A genetic component underlies these disorders in that patients often have a family history of sleepwalking, night terrors, or both (4). Sleepwalking and night terrors typically begin in childhood or early adolescence and are usually ‘ ‘outgrown’ ‘ by the end of adolescence, suggesting a delay in CNS maturation (5). When sleepwalking or night terrors have a postpubertal onset or continue into adulthood, however, psychopathology is a more significant causative factor (6, 7). These shared characteristics have led us to propose that sleepwalking and night terrors have a common etiology and are part of the same pathophysiologic spectrum (8). In this paper. we report on febrile illness as a precipitating factor for the onset of sleepwalking or night terrors. To our knowledge. this is the first report establishing this relationship. We have evaluated five children or adolescents who began to sleepwalk or to experience night terrors during or immediately after a febrile illness. The following three case reports illustrate our observations of this phenomenon.