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CC BY-NC-ND 4.0 · Sleep Sci 2023; 16(03): e354-e361
DOI: 10.1055/s-0043-1773787
Review Article

Forensic Evaluation of a Single Episode of a Disorder of Arousal in a Sleepwalking Defense: Cognitive Function Versus Prior Clinical History

Mark R. Pressman 
1   Pressman Sleep and Science Forensics, LLC, Ardmore, Pennsylvania, United States
2   Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, United States
3   Department of Medicine, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, Pennsylvania, United States
4   Charles Widger School of Law, Villanova University, Villanova, Pennsylvania, United States
› Author Affiliations Funding None.
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Abstract

Introduction The clinical diagnosis of disorders of arousal (DOA) is based primarily on a clinical history including amnesia for episodes. The presence of amnesia means the patient cannot provide direct evidence. In a forensic setting, when the defendant has been charged criminally with violent actions or sexual related assaults allegedly during sleep, a sleepwalking defense may be presented. As opposed to clinical history, the prosecution generally focuses on the single episode of alleged DOA that resulted in the criminal charges against the defendant. The prosecution will argue that this episode of complex behavior was not consistent with a DOA. A past history of purported episodes is not proof that a recent single episode must be a DOA. However, most sleepwalking defenses rely heavily on standard clinical evaluations despite the fact they have no direct connection with the current criminally charged episode.

The International Classification of Sleep Disorders (ICSD-3) General Diagnostic Criteria C for DOAs that states “limited or no associated cognition” should be present. Recent real time studies of DOAs have shown that during DOA episodes the prefrontal cortex (PRC) is deactivated while the motor cortex remains active.

Conclusion The PFC is the location of almost all executive functions including inhibition, planning, memory, and many others. Thus, when the PFC is deactivated, these higher cognitive functions are not available. The presence of higher cognitive functions during an alleged episode of DOA would be inconsistent with a deactivated PFC and thus inconsistent with generally accepted brain activity during a NREM parasomnia. This would be direct evidence that the episode could not be a DOA but occurred during wakefulness.

Clinical trial No.

Keywords

Disorder of Arousal - sleepwalking - prefrontal cortex - executive function - clinical diagnosis - forensic

Note

No off-label or investigational use.




Publication History

Received: 23 June 2022

Accepted: 09 November 2022

Article published online:
11 September 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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