- Email: [email protected]
WS-36-3 A bed partner is not always the best witness
Workshop 3Z H reflex, F-wave, silent period and blink reflex
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episodes, characterized by increased endozepine-4 activity. Methods and results. In 1990 we described a 63-year-old man with recurring stupors and comas and without toxic, metabolic or structural brain damage. E E G during the episodes showed a diffuse high-frequency (14-16 Hz) activity. Benzodiazepine-like activity in serum and CSF was markedly elevated, in the absence of exogenous benzodiazepines and barbiturates. Flumazenil, a benzodiazepine antagonist, normalized the E E G and awoke the patient. Endozepine-4 was markedly increased in the plasma and CSF during the episodes, returning to normal in-between attacks. To date, we have observed 20 patients (16 males, mean age 51 yrs) with similar clinical, EEG and pharmacological features, which characterize the new syndrome of Idiopathic Recurring Stupor (IRS). Conclusions. IRS is a syndrome of repeated stupors and comas, characterized by: the absence of toxic, metabolic and structural brain damage; fast 13-16 Hz non-reacting EEG activity; EEG normalization and clinical awakening after infusion of flumazenil; increased endozepine-4 levels in plasma and CSE The origin of the increased endozepine levels in IRS is still unsettled. 7
WS-36-21 Long-term course of patients with circadian rhythm sleep disorders Tatsuro Ohta, Toshiji Hayakawa 1, Yuhei Kayukawa, Tamotsu Okada z. Dept. of Psychiatry, Nagoya University School
of Medicine, 1Dept. of Laboratory, Nagoya University Hospital, 2 College of Medical Technology, Nagoya University, Nagoya, Japan Some studies have been reported on therapeutic trials for disorders of entrainment to external time cause such as delayed sleep phase syndrome (DSPS) and non-24-hour sleep-wake syndrome (=hypernychthemeral syndrome: HNS), but little information on the long-term prognosis of these disorders has been Known. Twenty-five patients (11 adolescents and 14 adults) with DSPS or HNS were intensively treated with non-pharmacological interventions (chronotherapy, phototherapy) and/or pharmacological agents (vitamin B12, triazolam) at our clinic during the period from 1980 to 1991. The follow-ups were obtained from 1.2 to 11.2 years after the initial treatment. The investigation was carried out with detailed questionnaires about current sleep conditions and social state. The severity of sleep rhythm disorder and the social adaptation level were evaluated in both adolescents and adults. The social adaptation level in adolescent patients had significantly improved and the severity level in adult patients showed statistically significant improvement. Both of the severity and social adaptation levels in all the DSPS patients showed significant improvement, suggesting the necessity of early discovery and early treatment of these disorders.
WS-36-31 A bed partner is not always the best witness Naoko Tachibana. Department of Brain Pathophysiology, Kyoto
University Faculty of Medicine, Kyoto, Japan Most of nocturnal events during sleep are unnoticed by patients themselves, and information from their bed partners is not always reliable partly because they are also sleeping at night and often their complaint is not interpreted properly by a physician who is unfamiliar with sleep medicine. R E M sleep behavior disorder, when manifested by typical clinical features, is easily suspected without all-night polysomnography (PSG), but R E M sleep motor dysfunction of mild degree or subclinical RBD is often disclosed only by all-night PSG with video recording. Supplementary motor
seizure (SMS) occurring only during sleep, which is equivalent to nocturnal paroxysmal dystonia (NPD) with short duration, can be diagnosed through video-EEG/PSG, even if no special telemetry system for epilepsy is available. Periodic leg movements (PLMs) are widely seen in elderly population and neurological patients, which are seldom suspected before all-night PSG unless the patients present with complaints of sleep disturbance. Snoring is a stigmata for sleep apnea syndrome, but irregular breathing is sometimes seen in cases of neurodegenerative diseases with autonomic dysfunction, and though infrequently, cases with lateral medullary lesions.
WS-36-4 ] Split-screen video and polysomnographic/EEG analysis Thoru Yamada, Mark Eric Dyken, Mark A. Granner. Division of
Clinical Electrophysiology, Department of Neurology, University of Iowa, Iowa city, IA, USA We present four patients for the evaluation of violent nocturnal, sleep related behaviors of unknown etiology. They were evaluated using Video/Polysomnographic (PSG)/EEG Monitoring. Patient #1 was a 34-year-old woman who presented with confusional arousals with screaming and violent movements that were found to be associated with progressive ictal (seizure) discharges from right temporal region which started during R E M sleep. Patient #2 was a 56-year-old gentleman who showed violent behavior from REM sleep that was associated with an elevated muscle tone during R E M and dream recall that was compatible with the R E M behavior disorder. Patient #3 was a 15-year-old girl who demonstrated rhythmic body rocking during N R E M sleep that was associated with progressive ictal discharges, with right greater than left frontal dominance. Patient #4 was an 8-year-old girl who had prolonged 2--4 hour episodes of body rocking, head and leg banging arising from N R E M sleep without epileptiform activity. Using Split-Screen video/Polysomnographic E E G Analysis, four patients with similar histories of violent nocturnal behavior were shown to have the diagnoses of nocturnal epilepsy, R E M related behavior disorder, and rhythmic movement disorder. This study illustrates the clinical usefulness of split-screen video and polysmnographic/EEG analysis.
WS-37. H REFLEX,F-WAVE, SILENT PERIODAND BLINK REFLEX [ WS-37-1 I Whither F waves - - clinical and research perspectives Morris A. Fisher. Departments of Neurology Hines VAH and Loyola Unfi~ersityStritch School of Medicine, USA F waves are low amplitude motor responses produced by backfiring of motoneurons in the anterior horn of the spinal cord. They have an established role in routine clinical electrophysiology and are intriguing because they represent an opportunity to evaluate motor physiology at the interface between the peripheral and central nervous systems. The use of F waves is complicated by the inherent variability of the responses and the need for F waves when passing peripherally to traverse a recently depolarized motoneuronal initial segment. The physiological and clinical significance of parameters used to analyze F waves - - latency, amplitude, persistence, and repeater waves - - will be presented as well as the number of F waves needed to describe these parameters meaningfully. The role of F waves in the evaluation of
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episodes, characterized by increased endozepine-4 activity. Methods and results. In 1990 we described a 63-year-old man with recurring stupors and comas and without toxic, metabolic or structural brain damage. E E G during the episodes showed a diffuse high-frequency (14-16 Hz) activity. Benzodiazepine-like activity in serum and CSF was markedly elevated, in the absence of exogenous benzodiazepines and barbiturates. Flumazenil, a benzodiazepine antagonist, normalized the E E G and awoke the patient. Endozepine-4 was markedly increased in the plasma and CSF during the episodes, returning to normal in-between attacks. To date, we have observed 20 patients (16 males, mean age 51 yrs) with similar clinical, EEG and pharmacological features, which characterize the new syndrome of Idiopathic Recurring Stupor (IRS). Conclusions. IRS is a syndrome of repeated stupors and comas, characterized by: the absence of toxic, metabolic and structural brain damage; fast 13-16 Hz non-reacting EEG activity; EEG normalization and clinical awakening after infusion of flumazenil; increased endozepine-4 levels in plasma and CSE The origin of the increased endozepine levels in IRS is still unsettled. 7
WS-36-21 Long-term course of patients with circadian rhythm sleep disorders Tatsuro Ohta, Toshiji Hayakawa 1, Yuhei Kayukawa, Tamotsu Okada z. Dept. of Psychiatry, Nagoya University School
of Medicine, 1Dept. of Laboratory, Nagoya University Hospital, 2 College of Medical Technology, Nagoya University, Nagoya, Japan Some studies have been reported on therapeutic trials for disorders of entrainment to external time cause such as delayed sleep phase syndrome (DSPS) and non-24-hour sleep-wake syndrome (=hypernychthemeral syndrome: HNS), but little information on the long-term prognosis of these disorders has been Known. Twenty-five patients (11 adolescents and 14 adults) with DSPS or HNS were intensively treated with non-pharmacological interventions (chronotherapy, phototherapy) and/or pharmacological agents (vitamin B12, triazolam) at our clinic during the period from 1980 to 1991. The follow-ups were obtained from 1.2 to 11.2 years after the initial treatment. The investigation was carried out with detailed questionnaires about current sleep conditions and social state. The severity of sleep rhythm disorder and the social adaptation level were evaluated in both adolescents and adults. The social adaptation level in adolescent patients had significantly improved and the severity level in adult patients showed statistically significant improvement. Both of the severity and social adaptation levels in all the DSPS patients showed significant improvement, suggesting the necessity of early discovery and early treatment of these disorders.
WS-36-31 A bed partner is not always the best witness Naoko Tachibana. Department of Brain Pathophysiology, Kyoto
University Faculty of Medicine, Kyoto, Japan Most of nocturnal events during sleep are unnoticed by patients themselves, and information from their bed partners is not always reliable partly because they are also sleeping at night and often their complaint is not interpreted properly by a physician who is unfamiliar with sleep medicine. R E M sleep behavior disorder, when manifested by typical clinical features, is easily suspected without all-night polysomnography (PSG), but R E M sleep motor dysfunction of mild degree or subclinical RBD is often disclosed only by all-night PSG with video recording. Supplementary motor
seizure (SMS) occurring only during sleep, which is equivalent to nocturnal paroxysmal dystonia (NPD) with short duration, can be diagnosed through video-EEG/PSG, even if no special telemetry system for epilepsy is available. Periodic leg movements (PLMs) are widely seen in elderly population and neurological patients, which are seldom suspected before all-night PSG unless the patients present with complaints of sleep disturbance. Snoring is a stigmata for sleep apnea syndrome, but irregular breathing is sometimes seen in cases of neurodegenerative diseases with autonomic dysfunction, and though infrequently, cases with lateral medullary lesions.
WS-36-4 ] Split-screen video and polysomnographic/EEG analysis Thoru Yamada, Mark Eric Dyken, Mark A. Granner. Division of
Clinical Electrophysiology, Department of Neurology, University of Iowa, Iowa city, IA, USA We present four patients for the evaluation of violent nocturnal, sleep related behaviors of unknown etiology. They were evaluated using Video/Polysomnographic (PSG)/EEG Monitoring. Patient #1 was a 34-year-old woman who presented with confusional arousals with screaming and violent movements that were found to be associated with progressive ictal (seizure) discharges from right temporal region which started during R E M sleep. Patient #2 was a 56-year-old gentleman who showed violent behavior from REM sleep that was associated with an elevated muscle tone during R E M and dream recall that was compatible with the R E M behavior disorder. Patient #3 was a 15-year-old girl who demonstrated rhythmic body rocking during N R E M sleep that was associated with progressive ictal discharges, with right greater than left frontal dominance. Patient #4 was an 8-year-old girl who had prolonged 2--4 hour episodes of body rocking, head and leg banging arising from N R E M sleep without epileptiform activity. Using Split-Screen video/Polysomnographic E E G Analysis, four patients with similar histories of violent nocturnal behavior were shown to have the diagnoses of nocturnal epilepsy, R E M related behavior disorder, and rhythmic movement disorder. This study illustrates the clinical usefulness of split-screen video and polysmnographic/EEG analysis.
WS-37. H REFLEX,F-WAVE, SILENT PERIODAND BLINK REFLEX [ WS-37-1 I Whither F waves - - clinical and research perspectives Morris A. Fisher. Departments of Neurology Hines VAH and Loyola Unfi~ersityStritch School of Medicine, USA F waves are low amplitude motor responses produced by backfiring of motoneurons in the anterior horn of the spinal cord. They have an established role in routine clinical electrophysiology and are intriguing because they represent an opportunity to evaluate motor physiology at the interface between the peripheral and central nervous systems. The use of F waves is complicated by the inherent variability of the responses and the need for F waves when passing peripherally to traverse a recently depolarized motoneuronal initial segment. The physiological and clinical significance of parameters used to analyze F waves - - latency, amplitude, persistence, and repeater waves - - will be presented as well as the number of F waves needed to describe these parameters meaningfully. The role of F waves in the evaluation of