Cases reported "Sleep Disorders"

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11/37. Periodic nocturnal myoclonus in a patient with hyperexplexia (startle disease).

    The periodic nocturnal myoclonus of a patient with hyperexplexia has been studied. Evidence has been given that the jerks are spontaneous arousal reactions. The temporal characteristics of the jerks have been analysed. The jerks appear to be correlated with the respiratory rhythm and the data suggest a correlation of the jerks with circulatory and respiratory higher order waves. The results are discussed with relation to the literature concerning spontaneous sleep jerks.
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12/37. Paroxysmal arousals during sleep.

    Six patients complained of distressing sudden awakenings with abnormal motor activity during sleep causing insomnia. polysomnography showed paroxysmal short-lasting arousals during NREM, especially slow-wave sleep, associated with complex movements and autonomic activation. Ictal and interictal EEG never showed epileptic discharges except in 1 patient who also had a tonic-clonic seizure during sleep. carbamazepine was the only effective medication in 2 patients. Paroxysmal arousals represent a sleep disturbance that may be related to deep epileptic foci.
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13/37. 24 hour polysomnographic evaluation in a patient with sleeping sickness.

    A 24 h polysomnographic recording was performed in a patient with sleeping sickness presenting an atypical neurological syndrome. trypanosoma gambiense was found in a lymph gland puncture and the CSF, and a serologic immunofluorescence test was positive. The scoring technique of the polygraphic traces had to be adapted because of the presence of a permanent EEG delta wave activity during the NREM sleep stages, and the method used by Schwartz and Escande (1970) was applied. REM sleep and wakefulness presented normal polygraphic characteristics. The patient had 8 sleep episodes throughout the recording period, occurring during the daytime and at night, forming the classical diurnal sleepiness and nocturnal restlessness of sleeping sickness. All but one episode represented 1-3 complete REM-NREM sleep cycles. On all occasions, REM latency was short and 2 SOREM episodes were observed. The nychthemeral organization of the stages of vigilance differed from one state to another. wakefulness and REM sleep had a circadian rhythmicity, while NREM sleep, total sleep time and deep sleep (corresponding to stages 3 and 4) had an ultradian periodicity. The concordance between the higher pressure for wakefulness and lower pressure for sleep around 20.00 h defined the time of occurrence of a 'forbidden zone' for sleep.
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14/37. A female case with the kleine-levin syndrome and its physiopathologic aspects.

    A female case with the kleine-levin syndrome (KLS), which first occurred at the age of 19, was discussed in relation to the following four characteristics: 1) a female case, 2) a loss of memory and the appearance of slow waves in the pathosis, 3) the abnormal pattern of growth hormone (GH) secretion during sleep in the pathosis, and 4) a prolonged latency between the peaks of III and V in the auditory brainstem response (ABR) in both the pathosis and nonpathosis. These characteristics may suggest that there is a slight disturbance of consciousness in the pathosis, and that there is a functional disturbance in the hypothalamus.
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15/37. Benign nocturnal childhood occipital epilepsy: a new syndrome with nocturnal seizures, tonic deviation of the eyes, and vomiting.

    An epileptic syndrome of benign nocturnal childhood occipital epilepsy with excellent prognosis is described. The syndrome is characterized by a clinical ictal triad of nocturnal seizures, tonic deviation of the eyes, and vomiting. There may be marching to involve the head and limbs, ending with a generalized tonic-clonic seizure. consciousness is usually, but not invariably, disturbed. Infrequent daytime fits may develop one to two years after remission of the nocturnal seizures. age of onset is usually from 3 to 5 years. Both sexes are involved. There is no family history of epilepsy or migraine. No definite causative factor was detected. The frequency of the seizures is very low with two children having only solitary ones. The interictal electroencephalographic features consist of repetitive occipital spike and slow wave complexes that are induced by closed eyes and darkness and are inhibited by open eyes and fixation with visual cues. It is proposed that this is a new idiopathic age-related-onset syndrome of the localization-related epilepsies.
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16/37. Benign neonatal sleep myoclonus. Relationship to sleep states.

    Neonatal sleep myoclonus is a benign syndrome characterized by myoclonic jerks occurring only during sleep and presenting in the first month of life. There are no associations with abnormal development, neurologic deficits, or seizures. The electroencephalogram is normal and has no correlation with the myoclonic jerks. The myoclonus is present in all sleep states although its frequency is state dependent and greatest during quiet sleep. It is not associated with an arousal response as previously thought. Transient serotonin imbalance and genetic factors might play a role in the pathogenesis of this disorder.
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17/37. kleine-levin syndrome with periodic apnea during hypersomnic stages--E.E.G. study.

    A 33 year old male, suffering from Kleine-Levine syndrome associated with periods of apnea during the hypersomnic attacks, is reported. Ventilatory studies negate the Pickwickian syndrome. The E.E.G.'s recorded during the hypersomnic attacks and the apneic periods showed a direct correlation between high-voltage delta waves paroxysmal E.E.G. activity, and apneic period. Medications known to improve kleine-levin syndrome, in our case, had no effect upon the clinical hypersomnic and apnea periods, nor on the correlatives E.E.G.'s pattern and spirometric studies. Theoretical considerations let us assume that these paroxysmal E.E.G. patterns associated with apnea are NRem-sleep serotonin dependent, and have an inhibitory influence on the respiratory centers, by alternating the equilibrium between the catecholamines and acetylcholine activities.
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18/37. Sleep, sleep apnea and the fibromyalgia syndrome.

    A patient who presented with primary fibromyalgia syndrome (PFS) was found to have sleep apnea. Since frequent wakening and nonrestorative sleep are prominent clinical complaints in both disorders, we hypothesized an etiologic relationship. A subsequent clinical survey of 11 additional sleep apneics revealed that 3 (27%) fulfilled proposed criteria for PFS. This was significantly greater than local and literature reported studies of nonrheumatologic patients and was comparable to reported prevalence of fibromyalgia in rheumatologic referral populations. A blinded sleep physiology study of 7 patients with PFS revealed a significantly increased percentage of transitional sleep and increased frequency of miniarousals/h, but no significant evidence of occult sleep apnea compared to matched normal controls. The frequent arousals of sleep apnea may be associated with fibromyalgia in some patients but do not explain the sleep disorder of PFS.
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19/37. Chronic behavioral disorders of human REM sleep: a new category of parasomnia.

    Four men, aged 67-72 years, had 4-month to 6-year histories of injuring themselves or their spouses with aggressive behaviors during sleep, often during attempted dream enactment. A 60-year-old woman had disruptive though nonviolent sleep and dream behaviors. polysomnography did not detect seizures but did document REM sleep pathology with variable loss of chin atonia, extraordinarily increased limb-twitch activity, and increased REM ocular activity and density. A broad range of REM sleep behaviors was recorded on videotape, including stereotypical hand motions, reaching and searching gestures, punches, kicks, and verified dream movements. Stage 3-4 slow wave sleep was elevated for age in all patients. NREM sleep was devoid of harmful behaviors, although three men had periodic myoclonus. There was no associated psychiatric disorder, whereas serious neurologic disorder was closely associated in four cases: olivo-ponto-cerebellar degeneration, guillain-barre syndrome, subarachnoid hemorrhage, and an atypical dementia. Two patients had immediate and lasting sleep behavioral suppression induced by clonazepam, and another patient had the same response with desipramine. All instances of drug discontinuation prompted immediate relapse. In four cases there was associated dream hyperactivity, which resolved with behavioral control. These REM sleep neurobehavioral disorders constitute another category of parasomnia, replicate findings from 21 years ago in cats receiving pontine tegmental lesions, and offer additional perspectives on human behavior, neurophysiology, pharmacology, and dream phenomenology.
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20/37. Rapid eye movement sleep behavior disorder. A treatable parasomnia affecting older adults.

    Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia defined by intermittent loss of electromyographic atonia during REM sleep with emergence of complex and vigorous behaviors. Punching, kicking, and leaping from bed during attempted dream enactment caused repeated injury in nine of our first ten adult patients. Mean age at onset was 62 years; nine of the patients were male. All patients underwent standard polysomnographic studies with videotaping of behaviors and extensive neurologic and psychiatric evaluations. The RBD was unrelated to psychopathologic conditions but in five cases was closely linked with major neuropathologic disorders: dementia (two), olivopontocerebellar degeneration, subarachnoid hemorrhage, and the guillain-barre syndrome. Other common polysomnographic abnormalities were high REM density, increased stage 3/4 (slow-wave) sleep, and both periodic and aperiodic limb twitching in non-REM sleep. Eight patients had dream changes involving motor overactivity and violent confrontations of dream characters. clonazepam induced rapid and sustained improvement of dream and sleep behavior problems in seven patients, as did desipramine hydrochloride in one patient.
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