Rhythmic Movement Disorder in Rapid Eye Movement Sleep in an Adult Patient Triggered by Abnormal Respiratory Events

Rhythmic movement disorder (RMD) is usually observed in children during drowsiness. However, here we present an adult patient experiencing RMD associated with Obstructive Sleep Apnea syndrome (OSAS) during rapid eye movement (REM) sleep. A 50-year old male was admitted with a complaint of head rocking during sleep for about one year. Video-polysomnography revealed OSAS (43/hour) and RMD. Following positive airway therapy, all the symptoms related to OSAS and head rocking disappeared. Adult-onset RMD occurring in REM sleep is rare; OSAS related arousals, increased cyclic alternating pattern, and possible association with REM sleep without atonia were suggested to be the underlying reasons for the condition

Survey of Reflex Seizure Precipitants in Epilepsy Patients

Objectives: Reflex seizures are proven epileptic seizures that accompany focal or generalized epilepsy syndromes and are precipitated by sensory/cognitive stimuli or motor activity. As there isn't much knowledge about reflex seizures, in daily practice at most epilepsy clinics, inquiries about reflex seizure precipitants are often not made. The aim of the present study was to determine number and type of reflex seizure precipitants identified by patients with epilepsy

What Does One Sleep-Onset REM Period-During Either Nocturnal Polysomnography or Multiple Sleep Latency Test-Mean in Differential Diagnosis of Central Hypersomnias?

Purpose:The differentiation of narcolepsy without cataplexy from idiopathic hypersomnia is based on the number of sleep-onset rapid eye movement periods (SOREMPs) observed by multiple sleep latency test (MSLT) and nocturnal polysomnography. The main aim of this study was to investigate the utility of SOREMP in differential diagnosis of central hypersomnias.Methods:The authors retrospectively evaluated consecutive 101 patients with a normal polysomnography other than the presence of SOREMP and/or REM without atonia and a latency of 8 minutes in MSLT.Results:The authors classified patients as follows: 52 patients had at least 2 SOREMPs (narcolepsy group), 23 had no SOREMPs (idiopathic hypersomnia group), and 26 patients had only 1 SOREMP (intermediate group). In polysomnographic recordings, both mean sleep latency and REM latency were significantly shorter in the narcolepsy (P = 0.012, P < 0.001, respectively) and intermediate groups (P = 0.005 and P = 0.035, respectively) compared with the idiopathic hypersomnia group. In MSLT recordings, sleep latency was 2.7 2.2 minutes in the narcolepsy group, 3.6 +/- 1.4 minutes in the intermediate group, and 5.2 +/- 2.7 minutes in the idiopathic hypersomnia group (P < 0.001). The mean REM latency and sleep stages SOREMPs arised from were similar between the narcolepsy and intermediate groups.Conclusions:To date, SOREMPs in MSLT and polysomnography remain the sole electrodiagnostic feature that discriminates narcolepsy without cataplexy from idiopathic hypersomnia. Different parameters or combined criteria are being increasingly investigated to increase the sensitivity and specificity of MSLT. The findings showed an altered instability of REM sleep not only in patients with 2 or more SOREMPs in MSLT but also in patients with one SOREMP

The role of sleep electroencephalography in patients with new onset epilepsy

Purpose: An increased propensity for seizures is associated with different stages of the sleep-wake cycle. In this study, we prospectively analyzed patients with new-onset epilepsy and investigated the clinical correlates of the yield obtained from sleep electroencephalography (EEG) recordings in patients with a normal wakefulness EEG

Demonstration of sympathetic dysfunction in patients with obstructive sleep apnea syndrome by measuring sympathetic skin responses from the neck

Objective: We aimed to study the sympathetic sudomotor responses via the sympathetic skin responses (SSR) from bilateral hands and right and left sides of the neck in patients with obstructive sleep apnea syndrome (OSAS)

Relationship Between Sleep-related Violence and NREM Parasomnia: A Case Report

Parasomnia constitutes an important group among the situations that can lead to sleep-related violence scene. Parasomnia attacks are characterized by complex motor behaviors of various degrees, violent behaviors may result in life-threatening and rarely lethal conditions for patients and their relatives. Here is presented a patient with right temporoparietal bone fracture, pneumocephalus and hemotympanum in right ear due to head trauma during a parasomnia attack. The diagnosis could be made by a detailed history taking and polysomnography only after many other investigations. In this context, we aimed to emphasize that not only nocturnal epilepsies, especially frontal lobe epilepsies, but also parasomnia attacks should be kept in mind in differential diagnosis of sleep-related violence

Acute-Onset Hemiparkinsonism Secondary to Subacute-Chronic Subdural Hematoma

Subdural hematomas constitute rare causes of secondary Parkinsonism in elderly. Subacute or chronic subdural hematomas occur in the elderly following minor head trauma or even without a remarkable history of trauma. A 69-year-old woman admitted with a rapidly progressive acute-onset hemiparkinsonism on the left side of her body. She denied any precipitating event before the onset of her symptoms, and her medical history was unremarkable. The anti-Parkinsonian therapy showed no benefit, but gradually worsening of the symptoms was observed. Her brain magnetic resonance imaging revealed a large subacute-chronic subdural hematoma on the right side with a mass effect on the basal ganglia structures, contralateral to her symptomatology. On thorough questioning, she confessed to having fallen out of the bed at night almost four weeks ago, three-weeks before the onset of her symptomatology. She had no complications associated with this fall and merely remembered this event. She denied any history of rapid eye movements (REM) sleep behavior disorder. The anti-Parkinsonian treatment was discontinued; the subdural hematoma was evacuated via burr hole drainage surgery. Her symptoms disappeared instantly after the surgery, with a normal neurologic examination one week after the surgery

Sleep bruxism is related to decreased inhibitory control of trigeminal motoneurons, but not with reticulobulbar system

Sleep bruxism (SB) is a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep. We aimed to understand the abnormal networks related to the excitability of masticatory pathways in patients with SB. Eleven patients with SB and age- and gender-matched 20 healthy subjects were prospectively enrolled in our study. The masseter inhibitory reflex (MIR) after electrical stimulation and auditory startle reaction (ASR) were examined. For MIR responses, durations of early and late silent period (SP) were shorter and the degree of suppression of SPs was significantly lower in SB group in comparison to those obtained in healthy subjects. The ASR responses even of the masseter muscle, however, were similar between patients with SB and healthy individuals. Abnormal MIR provides support for the decreased inhibitory control of the central masticatory circuits in SB whereas normal ASR suggests the integrity and normal functioning of brainstem pathways mediating startle reaction. Although the sample size is small, our results are in line with previous findings and suggest an abnormally decreased inhibition in trigeminal motoneurons to masseter muscle rather than reticulobulbar pathways in patients with SB

Evaluation of Sleep Structure and Sleep-related Disorders in Pediatric Patients Diagnosed with Duchenne Muscular Dystrophy and Spinal Muscular Atrophy

Objective: Duchenne muscular dystrophy (DMD) is a hereditary neuromuscular disorder in which respiratory problems arise secondary to the involvement of skeletal muscles. Spinal muscular atrophy (SMA) is a disorder group characterized by the involvement of anterior horn cells. The most common respiratory problems in DMD and SMA patients are pharyngeal muscle weakness in sleep and sleep-related respiratory disorders. In this study, we evaluated sleep structure and sleep-related disorders in pediatric age group diagnosed with DMD and SMA