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Table 1 Characteristics of kappa rhythm before exploding head syndrome (EHS) attacks
EHS
Examination
Sleep Kappa
Kappa
Time
from
stage
rhythm
rhythm
extinction of kappa
frequency
amplitude
rhythm
(Hz)
(µV)
EMG onset (s)
to
#1
PSG
N1
10
50
2.5
#2
MSLT subset 1
10
50
3.5
#3
MSLT subset 1
10
40
3.0
#4
MSLT subset 3
10
50
2.0
#5
MSLT subset 4
30
2.0
#6
MSLT subset 4
30
3.5
limb
EHS, exploding head syndrome; EMG, electromyography; PSG, polysomnography;
MSLT, multiple sleep latency test
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Figure Legends
Figure 1 Kappa rhythm waveform before EHS attack
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Kappa rhythm waveform is observed before an exploding head syndrome (EHS) attack (#2) in multiple sleep latency
test (MSLT) subset 1. The increase in electromyographic potential in the right upper limb, depicted by the red arrow,
indicates that the patient has noticed the explosive sound. In T3-M2 and T4-M1 derivations, 10 Hz and 50 µV
rhythmic waves with phase reversal appears (kappa rhythm) shown by blue dotted square. A 10 Hz posterior rhythm
is also observed. Reference electrodes (M1 and M2) are activated.
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Figure 2 Alpha band power of peri-exploding head syndrome (EHS) attacks in multiple sleep latency test (MSLT)
16
Alpha band power (8–11 Hz) of T3-T4 derivation of peri-exploding head syndrome (EHS) attacks is shown. The
horizontal axis indicates the time (second) when the occurrence of EHS is set to zero (shown as vertical dotted line).
The vertical axis represents the logarithm of alpha band power per second (a–e: a–e correspond with the EHS attacks
#2–6 shown in Table 1). Red circles indicate the local minimum power before the attacks.
(f) shows the alpha band power trend of five peri-EHS attacks with different colored lines corresponding to EHS
attacks # 2–6. The vertical axis represents the average alpha band power at 13–15-second epochs (E1–E6), and vertical
dotted line shows when the occurrence of EHS attack. Alpha band power increases prior to the attack and markedly
decreased thereafter. Alpha band power significantly changes (df=5, F=15.104, p < 0.001).
(g) shows the alpha band power in each epoch. The deviation contrast analysis is performed by comparing the mean
power of an epoch with the average power of all epochs, referred to the value of E1. In the epochs before and after
the EHS attack (E5 and E6), the alpha band power significantly increases and decreases (lower than significance level
of 0.01).
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