Shared local brain dynamics in pediatric and adult non-rapid eye movement parasomnias

STUDY OBJECTIVES: To characterize source-level cortical oscillatory dynamics before and during disorders of arousal (DoA) compared with physiological motor arousals in children and adults. MATERIALS AND METHODS: Nineteen children (10.9 ± 3.0 years) and 22 adults (30.3 ± 5.2 years) with DoA underwent 256-channel high-density EEG with video-polysomnography. Source-space spectral analysis in delta (0.5-4 Hz) and beta (18-30 Hz) bands was computed during stable slow-wave-sleep (-3 to -2 minutes before movement onset) and from -5 seconds to +15 seconds around movement onset for 84 DoA episodes and 146 physiological motor arousals. Linear mixed-effects models with permutation-based cluster correction were applied. RESULTS: Four reproducible cortical hallmarks emerged across age groups: (1) a widespread pre-onset increase in beta and delta relative to slow-wave-sleep; (2) sustained frontal delta enhancement over anterior cingulate, dorsomedial and ventromedial prefrontal, frontopolar, and orbitofrontal cortices; (3) concurrent centro-parietal delta suppression spanning posterior cingulate, precuneus, superior parietal, sensorimotor, and supplementary motor regions; and (4) persistent bilateral beta enhancement. Compared with physiological arousals, DoA arose from a "sleepier" background (higher delta, lower beta) and displayed greater beta coexisting with frontal delta persistence. Children showed broader pre-onset delta effects and more diffuse post-onset persistence, whereas adults exhibited a more anteriorly confined pattern. CONCLUSION: DoA display a reproducible, age-invariant cortical signature, consistent with a spatially organized failure of arousal integration: posterior sensorimotor and awareness circuits partially reactivate, while anterior executive and emotion-regulatory regions remain sleep-like. These spatiotemporal fingerprints position hd-EEG source analysis as a translational tool for mechanistically informed diagnostic and therapeutic development.