ABSTRACT
RESUMEN Existen enfermedades y condiciones que se presentan con movimientos involuntarios hipercinéticos de aparición súbita y remisión espontanea (episódicas). Dichas condiciones generan dificultades diagnósticas ya que por su carácter intermitente, en ocasiones no pueden ser evaluadas por el clínico.
SUMMARY During the last years, several drugs has been tried to try to diminish the impact of this condition and improve quality of life the people who suffer from dystonia. Oral therapy alone or in combination generates only partial symptom relief and most of the cases end up requiring other more invasive therapies.
Subject(s)
Nocturnal Paroxysmal Dystonia , Diagnosis, Differential , DystoniaABSTRACT
INTRODUCTION: Sleep disorders presenting involuntary movements may be very annoying to patients, apart from their negative influence on sleep. OBJECTIVE: To report the use of botulinum type-A toxin (BoNT-A) to manage the case of a patient whose sleep was severely disrupted by episodes of dystonic posturing of the right lower limb triggered by periodic limb movements of sleep (PLMS). METHOD: A 79-year-old woman with mild post-stroke right hemiparesis presented with recurrent painful episodes of dystonia of the right lower limb, which disrupted her sleep. The dystonic episodes could also be voluntarily triggered by extension of the right hallux. Polysomnography confirmed that the dystonic episodes were triggered by PLMS. Twenty units of BoNT-A (20U/500U vial) were injected into her right extensor hallucis longus. RESULTS: Shortly after BoNT-A was injected, the dystonic symptoms abated, and the patient achieved better sleep efficiency. CONCLUSION: The PLMS-related involuntary extension of the hallux was probably triggering the nocturnal post-stroke lower limb dystonic paroxysms. BoNT-A injection into the right extensor hallucis longus was effective in managing this condition and thus resolved the associated disruption of sleep.
INTRODUÇÃO: Desordens do sono apresentando movimentos involuntários podem ser bastante perturbadoras aos pacientes, além de sua influência negativa no sono. OBJETIVO: Descrever o uso da toxina botulínica tipo-A (BoNT-A) no manejo do caso de um paciente cujo sono estava gravemente fragmentado por episódios de distonia do membro inferior direito, desencadeados por movimentos periódicos do sono (MPS). MÉTODO: Uma paciente com 79 anos portadora de hemiparesia direita leve seqüelar a isquemia cerebral (AVCI) procurou-nos por episódios dolorosos recorrentes de distonia noturna de seu membro inferior direito, os quais fragmentavam seu sono. Os episódios de distonia também podiam ser desencadeados voluntariamente, por extensão do hálux direito. Uma polisonografia confirmou que os episódios distônicos eram desencadeados pelos MPS. Vinte unidades de BoNT-A (20 U/frasco de 500 U) foram injetadas no seu extensor longo do hálux. RESULTADOS: Alguns dias após a injeção de BoNT-A os sintomas distônicos regrediram, e o sono da paciente tornou-se eficiente. CONCLUSÃO: As extensões involuntárias do hálux relacionadas aos movimentos periódicos do sono estavam provavelmente desencadeando os paroxismos distônicos noturnos pós-AVCI. A injeção de BoNT-A no extensor longo do hálux foi eficaz no manejo desta condição, resolvedo assim a fragmentação do sono.
Subject(s)
Aged , Female , Humans , Botulinum Toxins, Type A/therapeutic use , Neuromuscular Agents/therapeutic use , Nocturnal Myoclonus Syndrome/drug therapy , Nocturnal Paroxysmal Dystonia/drug therapy , Stroke/complications , Nocturnal Myoclonus Syndrome/etiology , Nocturnal Paroxysmal Dystonia/etiology , Polysomnography , Treatment OutcomeABSTRACT
Distinguishing epileptic seizure from non-epileptic seizure is a common diagnostic problem. Neurogenic or cardiac syncope can appear similar to atonic and even convulsive seizures. Classic migraine and transient ischemic attacks may also resemble epileptic seizures. Sleep disorders including REM sleep behavior disorder, nocturnal paroxysmal dystonia, and narcolepsy likewise simulate an epileptic seizure. Movement disorders such as paroxysmal dyskinesia can be misinterpreted as epileptic seizures (reflex epilepsy or myoclonic seizures). Psychogenic seizures are often misdiagnosed as an intractable epilepsy. Prior to the definitive diagnosis of epilepsy, possible non-epileptic seizures should be excluded. For the correct decision, a thorough and systematic history taking is important. In addition, EEG, pseudoseizure induction test, head-up tilt test, EKG, sleep studies, and video-EEG monitoring may be necessary. Misdiagnosis of non-epileptic seizures as epilepsy may result in unnecessary anti-epileptic drug use. At the same time, we should let the patients understand what the epilepsy is and that epilepsy is a treatable disease.
Subject(s)
Humans , Chorea , Diagnosis , Diagnostic Errors , Drug Resistant Epilepsy , Electrocardiography , Electroencephalography , Epilepsy , Ischemic Attack, Transient , Linear Energy Transfer , Migraine with Aura , Movement Disorders , Narcolepsy , Nocturnal Paroxysmal Dystonia , REM Sleep Behavior Disorder , Seizures , Sleep Wake Disorders , SyncopeABSTRACT
Nocturnal paroxysmal dystonia is characterized by brief, abrupt, dystonic or dyskinetic movement during NREMsleep. It has been considered as a form of nocturnal frontal lobe epilepsy. A 35-year-old man complained of sleep disturbance and abnormal movement during sleep. In video-polysomnography recordings, he showed frequent stereotyped abnormal dystonic movements in upper and lower extremities. The dystonic movements occurred during stage IV sleep. He was treated with carbamazepine and the symptoms improved. (J Korean Neurol Assoc 19(3):305~308, 2001)