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ABSTRACT: To describe three cases of sleep related, idiopathic rhythmic movement disorder (RMD) with atypical headbanging, consisting of head punching and head slapping.
Three consecutive patients (2 males [11 and 13 years old) and one female [22 years old]) presented with atypical headbanging of 6 years, 7 years, and 17 years duration. In 2 cases, typical rhythmic headbanging (with use of the head) shifted after 3-4 years to atypical headbanging, with frontal head punching that was quasi-rhythmic. In one case, atypical headbanging (head-slapping) was the initial and only RMD. There was no injury from the headbanging. Prenatal, perinatal, developmental, behavioral-psychological, medical-neurological, and family histories were negative. Clinical evaluations and nocturnal video-polysomnography with seizure montage were performed on all patients.
Atypical headbanging was documented in all 3 cases; episodes always emerged late in the sleep cycle: from N2 sleep in 11 episodes, from REM sleep in 4 episodes, and from N1 sleep in 1 episode. Epileptiform activity was not detected. Clonazepam therapy was substantially effective in 1 case but not effective in 2 cases.
These 3 cases of idiopathic atypical headbanging expand the literature on this RMD variant, as to our knowledge only one previously documented case has been reported.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2012; 8(4):403-11. · 3.23 Impact Factor
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ABSTRACT: This is the first report describing the efficacy of modafinil therapy for narcolepsy in patients in Taiwan. The purpose of this study was to compare the objective Multiple Sleep Latency Test (MSLT) and the subjective Epworth Sleepiness Scale (ESS) for evaluating the efficacy of modafinil in treating excessive daytime sleepiness in patients with narcolepsy in Taiwan. Ten consecutive patients with narcolepsy-with-cataplexy who were treated with 200 mg/day modafinil for more than 6 months at our sleep center between January 2003 and December 2007 were included in this study. This comparative study was prompted by the requirement of the Bureau of National Health Insurance in Taiwan that modafinil users need to be followed up with MSLTs every 6-12 months. The mean age at onset of narcolepsy onset in these 10 patients was 11.8 +/- 3.3 years, and eight (80%) were male. We compared the differences in MSLT and ESS between baseline and follow-up at 6-12 months after starting modafinil therapy using paired t tests. ESS scores (p < 0.001) were considerably more sensitive than MSLT scores (p < 0.05) in documenting efficacy of modafinil and that the improvements in MSLT scores were minimal and remained in the pathologically sleepy range. These findings suggest that the ESS is a more sensitive and clinically meaningful tool to evaluate the efficacy of modafinil in narcolepsy.
The Kaohsiung journal of medical sciences 08/2010; 26(8):422-7. · 0.61 Impact Factor
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ABSTRACT: We report the case of an 88-year-old man with Alzheimer's disease (AD) of 8 years duration (emerging shortly after the de novo onset of sleeptalking) who developed REM sleep behavior disorder (RBD) after increasing the nightly dose of rivastigmine, an acetylcholinesterase inhibitor, from 1.5 mg to 3 mg (total daily dose, 4.5 mg), as therapy for his dementia. His family then became aware of recurrent nocturnal episodes arising from sleep of his leaving bed, and he sustained multiple abrasion injuries from falling down. Polysomnography (PSG), utilizing a seizure montage with fast paper speed, conducted with the patient taking rivastigmine 3 mg at bedtime, documented 3 abrupt episodes of bilateral arm-waving with moaning and shouting that emerged exclusively during each of the 3 REM sleep periods, with the duration of the episodes lasting 8 to 25 seconds. No epileptiform discharge appeared with the onset of these REM sleep behaviors. Therapy with clonazepam, 0.5 mg at bedtime (with ongoing 3 mg bedtime and 4.5 mg total daily rivastigmine therapy), fully suppressed the sleep-related events, with prompt relapse whenever clonazepam was not taken. This is the second reported case (both males with AD) of rivastigmine-induced RBD, and the oldest reported case of RBD; and it represents reversible, medication-induced, acute RBD.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 04/2010; 6(2):192-5. · 3.23 Impact Factor
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ABSTRACT: We report the case of a 8-year-old girl with a 3-month history of sleep-related screaming during both the night and daytime naps. A terrified expression accompanied the episodes of screaming, often with dream mentation and clouded consciousness. Her parents witnessed up to 5-6 episodes every night, with each episode lasting for less than 1 minute. A polysomnographic study documented six episodes of paroxysmal screaming without limb movement, with all episodes emerging from stage 2 non-REM sleep, and episode duration usually lasting 30-60 seconds. Suppression of the generalized background EEG activity occurred for 5-10 seconds before the onset of epileptiform activities (a run of sharp waves) and the onset of screaming. Brain MRI revealed right orbitofrontal lobe cortical dysplasia. Therapy with oxcarbazepine, 300 mg at bedtime, fully suppressed the sleep-related events, with a prompt relapse whenever the medication was not taken. Daytime wakeful seizures eventually appeared, and the girl had a seizure attack characterized by generalized choreiform and dystonic movements lasting for less than one minute, without any postictal confusion. Her consciousness was fully preserved during the attack. This patient had typical and atypical features of frontal lobe epilepsy.
Acta neurologica Taiwanica 12/2009; 18(4):281-6.
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ABSTRACT: This is a case of a 29-year-old man with a 6 year history of sleep-related eating disorder (SRED) that occurred with partial consciousness on a nightly basis. His family or wife witnessed up to 5 episodes every night, with each eating episode lasting 8-16 minutes. Polysomnography documented 4 episodes of sleep-related eating arising from stage 2 Non-REM sleep, when he consumed cookies that he had brought to the sleep lab that night. While eating, his EEG remained in stage 2 sleep or else was a wakeful EEG, and the eating episodes lasted for a mean 13.3 minutes. There was no epileptiform EEG activity during the polysomnogrphic study with a seizure montage and fast paper speed. Therapy with clonazepam, 0.5 mg bedtime, did not control the nocturnal eating. The patient tried to limit access to food in his home before bedtime, and this had modest benefit. This case of SRED has both typical and atypical features, which are discussed.
Acta neurologica Taiwanica 07/2007; 16(2):106-10.
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ABSTRACT: A 35-year-old woman with childhood-onset parasomnia, marked by arm waving with talking and shouting, developed marital discord solely because her parasomnia disrupted her husband's sleep. She became progressively depressed after her husband began to sleep in a separate bedroom, eventually becoming acutely suicidal. There had been no psychiatric history prior to her marriage. An evaluation with a sleep specialist-neurologist and polysomnographic monitoring confirmed the diagnosis of idiopathic REM sleep behavior disorder (RBD). Treatment with clonazepam, 1.0-1.5 mg at bedtime controlled her RBD and she again slept with her husband, which fully resolved their marital discord and her secondary depression.
Sleep Medicine 04/2004; 5(2):151-4. · 3.40 Impact Factor
