1344 Nighttime Deceptions, Melatonin Corrections: A Novel Case of Melatonin-Responsive Complex Nocturnal Hallucinations in a Child
Abstract
Complex nocturnal visual hallucinations arise during sleep onset or nighttime awakenings and can be a significant source of anxiety for children and their caregivers. Although isolated reports have described successful treatment with melatonin in adults, its efficacy in pediatric patients has not been reported. Herein, we present the first known pediatric case of complex nocturnal visual hallucinations demonstrating a dramatic response to melatonin.
A 6-year-old female with no significant neurological comorbidities presented with frequent, intricate visual hallucinations associated with poor sleep quality and daytime fatigue. The hallucinations, occurring nightly for three weeks, involved seeing worms crawling over her body and bedroom during nocturnal awakenings to use the restroom. She was fully awake during the events, which lasted 1–2 hours, and had full recollection of events in the morning. Past history included transient nocturnal hallucinations several years prior during her father’s military deployment that self-resolved and a history of snoring but no sleep-disordered breathing on polysomnogram. She also endorsed symptoms of restless leg syndrome separate from her visual hallucinations and was started on oral iron therapy for sub-optimal ferritin levels. Standard sleep hygiene and behavioral interventions were ineffective. Evaluation with pediatric psychology identified symptoms of anxiety but did not identify any additional psychiatric disorders, psychological…
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