There was no history of similar illness, epilepsy, or excessive daytime sleepiness in the family. The subject regularly used alcohol and smoked cigarettes for the past 25 years. There was no significant illness in the past. There was no aura, presyncopal symptoms, generalized tonic clonic seizures, tongue biting, frothing, incontinence, or major injuries. Excessive dreaming was observed during the preceding 4-5 months, to the extent that at times he would hallucinate in wakefulness and would feel himself talking to long-deceased friends and family members. Snoring was occasionally noted without choking or apneic spells, restless legs, limb movements, or other abnormal behavior in sleep. Increased daytime somnolence was also noted during the preceding 2 years. The initial frequency (1-2/week) had recently increased to multiple daily episodes and were almost continuous for preceding one month. There was no correlation with change in mood or emotional situations. The events would occur while standing, walking, talking, conversing over telephone, watching TV, pressing a doorbell, or even eating. Though briefly unresponsive, he was aware and arousable both during and after the attacks.
The subject would also inadvertently drop objects or stumble. At times this was associated with closure of eyes and transient change in character of voice. A 57-year-old gentleman presented with recurrent episodes of head jerking resulting in repetitive head nodding for 6 months.
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