SLEEP-RELATED HYPERMOTOR (HYPERKINETIC) EPILEPSY (SHE)

	Mandatory	Alerts	Exclusionary
Seizures	Brief focal motor seizures with hyperkinetic or asymmetric tonic/dystonic features occurring predominantly from sleep	Seizures predominantly from the awake state	Seizures only during wakefulness Generalized onset seizures
EEG		Frequent epileptiform abnormality outside frontal regions Generalized epileptiform abnormality
Age at onset		<10 or >20 years	<2 months or >64 years
Development at onset		Moderate or greater intellectual impairment
Neurological exam		Abnormal examination
Imaging
Are MRI or ictal EEG required for diagnosis? An MRI is not required for diagnosis but should be done to evaluate for underlying cause An ictal EEG is not required for diagnosis
Syndrome without laboratory confirmation: in resource-limited regions, this syndrome can be diagnosed if other mandatory and exclusionary criteria are met, and the patient has witnessed or video-recorded hyperkinetic seizures during sleep

NOTE Alert criteria are absent in the vast majority of patients with the syndrome, but rarely can be seen. Their presence should result in caution in diagnosing the syndrome and consideration of other conditions