Brief Answer:
Has he had a sleep study?

Detailed Answer:
Good afternoon.

The symptom of opening one's eyes but only being able to move or respond to people or things in one's environment should always bring to mind the possibility of a sleep disorder known as narcolepsy although if he only developing this disorder now in life it is clearly a very late onset type of situation.

Most people with narcolepsy will present at much younger ages. Perhaps, he's had these symptoms for some time and they've simply become worse?

Another possibility to consider whenever someone comes out of what was a sleep state but is unresponsive as you describe could be some form of seizure such as complex partial epilepsy or in layman's terms, petit mal seizures. Again, this is a late age to be presenting this type of picture unless he has some structurally wrong with the brain or there are chemical imbalances that have developed as of late with electrolytes or other elements?

If he's been ruled out for stroke and had an MRI of the brain then, certainly the possibility of that or a tumor or bleed have already been discarded. But for the diagnosis of seizure disorder I would recommend finding out from the doctor who is taking care of him whether or not he got an MRI with gadolinium contrast....NOT A CT SCAN of the head but rather an MRI with GADOLINIUM CONTRAST.

In addition, he should get a SEIZURE PROTOCOL done with the MRI which means they should take FINE CUTS through the TEMPORAL LOBES. That needs to be clearly specified in the orders for the MRI otherwise, it won't be done and the ordering physician should write it OUT.....if it's neurologist they are likely aware of this type of order and how to make sure the radiologist goes about setting the right test up and doing it properly with the sequences, etc.

If it's someone other than a neurologist writing the order then, don't be bashful to spell it out because otherwise, it will likely NOT GET DONE properly and then, he'll just have to have the study redone because the results may not be valid.

In addition, your brother should get a sleep study looking for sleep apnea, sleep architecture mapping, and MSLT's (Mean Sleep Latency Tests) done which again are tests that SHOULD BE SPECIFIED by the ordering physician otherwise they, will not necessarily do them automatically and for the DIAGNOSIS going in to the study the physician should SPECIFY that they are trying to rule out NARCOLEPSY given this patient's possible episodes of SLEEP PARALYSIS.

Finally, an EEG (Electroelectroencephalogram) should be performed and if I were his physician I might try something like making his do a SLEEP DEPRIVED study with a prolonged recording of at least 60-90 minutes. This means that the patient should be instructed to arise 2-3 hrs. ahead of their usual time of getting up in the mornings. When the EEG is run I would also specify to the EEG technician that they are to encourage your brother to fall asleep as quickly as possible and to stay asleep for at least 45-60 min. of the recording and then, for someone to gently or lightly awaken the patient to see if the same phenomenon while at home of his being unable to move can be duplicated and recorded in terms of brain wave activity.

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