Improved sleep and neurocognitive functions in a child with thalamic lesions on sodium oxybate

Frequent arousals with sleep fragmentation have been correlated with difficulties in emotion/behavioral regulation, attention, and cognitive functioning in children with sleep disorders.1 Sodium oxybate, also known as γ-hydroxybutyrate (Xyrem), is a highly regulated and controlled substance currently approved in the United States for the treatment of cataplexy accompanying narcolepsy2 and also improves daytime sleepiness in patients with narcolepsy.3 Recent studies using sodium oxybate in patients with fibromyalgia improved sleep patterns, including decreased alpha intrusion, sleep fragmentation, and increased slow wave sleep along with improvement in symptoms of pain and fatigue.4 We report an 8-year-old boy with bithalamic lesions with daytime attention and behavioral difficulties and severely disturbed sleep patterns since age 4, who was unresponsive to treatment with traditional medications and interventions but was successfully treated with sodium oxybate. An 8-year-old boy with past medical history of acute alteration in consciousness and change in cognitive functioning at age 4 had brain MRI showing bithalamic enhancing signal …