Shared local brain dynamics in pediatric and adult NREM parasomnias

Disorders of arousal (DoA), a group of Non-Rapid Eye Movement parasomnias--including sleepwalking, night terrors, and confusional arousals--arise from incomplete awakenings during slow-wave sleep, yet their neural signatures remain poorly defined. Using high-density EEG and source-space spectral analysis in both children and adults, we mapped cortical dynamics in the seconds before and after DoA onset and compared them to physiological motor arousals. Across ages, DoA episodes emerged from a globally less activated cortical state, with pre-onset surges in delta and beta power peaking in premotor, orbitofrontal, and anterior cingulate cortices. After onset, episodes showed widespread beta enhancement and focal delta suppression in sensorimotor and parietal associative regions relative to stable slow-wave sleep, alongside sustained frontal delta and beta activity compared with physiological motor arousals. These age-invariant spatial patterns identify a stable neurophysiological signature of DoA, supporting the concept of local sleep-wake dissociation. Our findings provide a framework for mechanistic models and potential biomarkers to modulate, predict, and differentiate DoA from other nocturnal events.