02 Jun Sleep and Its Abnormalities (Parasomnias)
Abnormal Movements in Sleep
Abnormal movements in sleep, also called parasomnias, are relatively common. They cover a broad spectrum, ranging from physiologic phenomena such as isolated twitching to complex behaviors and serious disease (Figure 1.).
In this Newsletter we will touch on a few of the most common disorders:
- Nocturnal epileptic seizures should be suspected if rhythmic, clonic movements occur in sleep and the affected person cannot be awakened afterward; if tongue-biting occurs in sleep (manifested, perhaps, by blood on the pillow); if bedwetting appears and was not previously a problem; or if the patient has pain in the limbs and/or headache in the morning.
- Periodic limb movements in sleep: consists of repetitive twitching of the feet, the toes, or even both legs during sleep. Such movements are seen in 80% of patients with RLS and also common in Parkinson disease and narcolepsy. They can occur in healthy elderly persons as well.
- Bedwetting (enuresis) usually reflects the delayed development of nighttime continence in children and adolescents and resolves spontaneously.
- Sleepwalking, pavor nocturnus (night terror) and confused awakening all occur as the sufferer is awakening from a deep sleep. They are thought to be due to a dissociated brain state in which the motor centers are already awake and active, but the brain areas subserving memory and control are still asleep. In sleepwalking, the individual actually gets out of bed; in confused awakening, he or she briefly sits up and seems confused.
- Pavor nocturnus (night terror) consists of expressions of intense fear, including crying and screaming, that last about ten minutes. During night terrors, the eyes are open, but the individual does not respond in the normal way to external stimuli.
- REM sleep behavior disorders (RBD) or REM without atonia: the normal atonia of REM sleep is lacking, generally occur in the second half of the night. Most of the affected persons are elderly men. These disorders are characterized by complex behaviors, often of an aggressive or auto-aggressive nature, e.g., wild thrashing of the limbs, as if the patient were acting out a dream. Some recent literature suggests this may be an early warning sign for Parkinson’s disease.
Practical Considerations:
The differential diagnosis of abnormal movements in sleep (parasomnias) should always include nocturnal twilight states with behavioral automatisms as a manifestation of temporal or frontal lobe epilepsy, particularly when similar disturbances occur during the day or a temporal or frontal brain lesion is present.
The diagnosis of some of those are established by video-polysomnography.
Reference
Mattle, Heinrich, and Marco Mumenthaler. Fundamentals of Neurology: An Illustrated Guide, Thieme Medical Publishers, Incorporated, 2016. Chapter 10. Sleep and its abnormalities. 10.4 Abnormal movements in sleep (parasomnias) Copyright © 2016. Thieme Medical Publishers, Incorporated. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/unal/detail.action?docID=4776505. Created from unal on 2018-03-07 22:18:32.