Cotard parasomnia: le délire de negation that occur during the sleep-wake dissociation?

Three patients with non-REM parasomnias experienced episodes of Cotard delusion—believing they were dead or dying and unable to perceive their bodies as their own. These nihilistic mentations occurred during confusional arousals from sleep and were accompanied by panic. EEG source analysis indicated right-hemispheric hypoactivity during the episodes. The authors argue that aberrant activation of the salience network and default mode network—two major intrinsic networks of wakefulness—underlies these states. Such dreamlike mentations are rarely remembered and likely underreported, but can cause significant distress and worsen clinical outcomes if unaddressed.

Study at a glance

Abstract

Unpleasant dreamlike mentation can occur during non-rapid eye movement parasomnias, leading to associated panic attacks. The mentations are rarely remembered and are likely underreported. However, they may lead to significant personal distress and, if not addressed, may contribute to poorer clinical outcomes. Cotard le délire de negation are very rare nihilistic delusions, historically described with psychotic disorders. Their association with a variety of neurologic disorders, including migraine and cluster-headache, has also been reported. Here we present three cases of Cotard parasomnia during which distinct states of consciousness defined by nihilistic ideation occurred. Patients described believing they are dead or dying, while unable to perceive or experience their bodies in whole, or in part, as their own. A source analysis of the electroencephalographic fingerprint of these mentations suggests right-hemispheric hypoactivity subsequent to confusional arousals. Mechanistically, an aberrant activation of two major intrinsic brain networks of wakefulness, the salience network and the default mode network, is argued.