Is It Psychogenic Non‐Epileptic Event, Sleep Related Rhythmical Movement Disorder or Hypermotor Seizure?

Distinguishing non‐epileptic events from epileptic seizures remains a clinical challenge, particularly when occurring exclusively during sleep. Sleep‐related rhythmical movement disorder (SRRMD) is a benign condition typically seen in early childhood, characterised by stereotyped, rhythmical repetitive movements involving large muscle groups, predominantly during Stage II of non‐REM sleep. These movements can closely mimic features of sleep parasomnias, hypermotor seizures or psychogenic non‐epileptic seizures (PNES), complicating the diagnostic approach. We present a case of an adolescent female with comorbid SRRMD and PNES and a clinical approach to distinguish between them.