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

Valentina Gnoni, Sean Higgins, Alexander David Nesbitt, Danielle Wasserman, Iain Duncan, Adam Birdseye, Laura Pérez-Carbonell, Panagis Drakatos, Michaelis Koutramanidis, Luigi Ferini-Strambi, Guy Doron Leschziner, Ivana Rosenzweig

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)971-976
Number of pages6
JournalJournal of Clinical Sleep Medicine
Issue number6
Publication statusPublished - Jun 15 2020


  • Cotard delusion
  • Default mode network
  • EEG
  • Major intrinsic networks
  • Non-REM parasomnia
  • Salience network
  • Sleep
  • Sleep-wake transition

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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