High-density EEG power topography and connectivity during confusional arousal.

Castelnovo, Anna; Amacker, Julian; Maiolo, Massimo; Amato, Ninfa; Pereno, Matteo; Riccardi, Silvia; Danani, Andrea; Ulzega, Simone; Manconi, Mauro (2022). High-density EEG power topography and connectivity during confusional arousal. Cortex, 155, pp. 62-74. Elsevier 10.1016/j.cortex.2022.05.021

1-s2.0-S0010945222001915-main.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (2MB) | Preview

Confusional arousal is the milder expression of a family of disorders known as Disorders of Arousal (DOA) from non-REM sleep. These disorders are characterized by recurrent abnormal behaviors that occur in a state of reduced awareness for the external environment. Despite frequent amnesia for the nocturnal events, when actively probed, patients are able to report vivid hallucinatory/dream-like mental imagery. Traditional (low-density) scalp and stereo-electroencephalographic (EEG) recordings previously showed a pathological admixture of slow oscillations typical of NREM sleep and wake-like fast-mixed frequencies during these phenomena. However, our knowledge about the specific neural EEG dynamics over the entire brain is limited. We collected 2 consecutive in-laboratory sleep recordings using high-density (hd)-EEG (256 vertex-referenced geodesic system) coupled with standard video-polysomnography (v-PSG) from a 12-year-old drug-naïve and otherwise healthy child with a long-lasting history of sleepwalking. Source power topography and functional connectivity were computed during 20 selected confusional arousal episodes (from -6 to +18 sec after motor onset), and during baseline slow wave sleep preceding each episode (from - 3 to -2 min before onset). We found a widespread increase in slow wave activity (SWA) theta, alpha, beta, gamma power, associated with a parallel decrease in the sigma range during behavioral episodes compared to baseline sleep. Bilateral Broadman area 7 and right Broadman areas 39 and 40 were relatively spared by the massive increase in SWA power. Functional SWA connectivity analysis revealed a drastic increase in the number and complexity of connections from baseline sleep to full-blown episodes, that mainly involved an increased out-flow from bilateral fronto-medial prefrontal cortex and left temporal lobe to other cortical regions. These effects could be appreciated in the 6 sec window preceding behavioral onset. Overall, our results support the idea that DOA are the expression of peculiar brain states, compatible with a partial re-emergence of consciousness.

Item Type:

Journal Article (Further Contribution)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy

UniBE Contributor:

Castelnovo, Anna, Maiolo, Massimo Vincenzo, Manconi, Mauro


600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology








Pubmed Import

Date Deposited:

22 Aug 2022 10:48

Last Modified:

05 Dec 2022 16:22

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Disorders of arousal NREM-sleep parasomnia Night terror Pavor nocturnus Somnambulism





Actions (login required)

Edit item Edit item
Provide Feedback