Behavioural and Neurophysiologic Features of State Dissociation: A Brief Review of the Literature and Three Descriptive Case Studies

Wakefulness, rapid eye movement (REM) and non-REM sleep are not always mutually exclusive conditions, as commonly assumed. In some cases, the declaration of any state may be incomplete and states can fluctuate rapidly, resulting in peculiar behavioural syndromes such as narcolepsy, REM sleep behaviour disorder and status dissociatus. We briefly introduce this topic and discuss three suggestive clinical cases

Restless Legs Syndrome is Frequent in Narcolepsy with Cataplexy Patients

Study Objectives: To investigate the occurrence of restless legs syndrome (RLS) in narcolepsy with cataplexy (NC).Design: A case-control study assessing the frequency of comorbidity of RLS and NC in three European sleep disorder centers.Patients: Three sleep research centers recruited 184 NC patients and 235 age-matched controls.Interventions: N/AMeasurements and Results: NC patients and controls underwent a face-to-face interview investigating demographics, medical and drug history, sleep habits, and sleep disorders, in particular RLS based on the 4 international criteria and on a frequency >= 2 times/week, with a detailed description of RLS symptoms when present. RLS was significantly more prevalent among NC patients (14.7%) than in controls (3.0%). The age at onset of RLS in NC patients fits with the age at onset in idiopathic RLS, and RLS appeared more than 10 years after NC onset. Unlike idiopathic RLS, RLS in NC subjects was not more prevalent in women and was less familial (15.4% of cases). Lastly, NC patients with RLS showed a moderate disease severity and an almost daily occurrence of symptoms, which were also diurnal in 35% of cases.Older age, higher blood ferritin levels, and sleep paralysis seem to have a predictive value for RLS in NC. The higher ferritin levels indicate that different pathophysiological mechanisms underlie secondary RLS associated with NC.Conclusions: This study highlights the association between RLS and NC. The nature of this association is still investigational, but it does indicate that RLS must be addressed in the evaluation and management of nocturnal sleep impairment in NC patients