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European Neurology 2019Amputees often experience a phantom limb consisting in the vivid impression that the limb is not only still present, but in many cases, painful. These patients may also... (Review)
Review
BACKGROUND
Amputees often experience a phantom limb consisting in the vivid impression that the limb is not only still present, but in many cases, painful. These patients may also become restless legs syndrome (RLS) sufferers; conversely, a preexisting RLS may persist after limb amputation.
SUMMARY
In this brief essay, papers on phantom RLS (pRLS) are reviewed in order to provide clinical elements for the diagnosis and treatment of this peculiar condition. It is relevant that dopamine receptor agonists yielded a marked reduction of the RLS symptoms in all cases reported. Key Messages: pRLS indirectly confirms the innate capacity of the central nervous system to retain a primordial internal body image responsible of phantom sensations. Moreover, it has been hypothesized that pRLS may provide clues for a better comprehension of some mechanisms underlying phantom pain and for the development of new treatment strategies.
Topics: Humans; Phantom Limb; Restless Legs Syndrome
PubMed: 31536997
DOI: 10.1159/000503103 -
Revista de Neurologia Nov 2020Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as... (Review)
Review
Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as restless legs syndrome, periodic leg movements, and REM and NREM parasomnias. The knowledge of their clinical features and management is of utmost importance for the neurologist and sleep specialist. Frequently, these patients are referred to such specialists and it is relevant to know that certain sleep disorders may be associated with other neurological conditions.
Topics: Adult; Humans; Parasomnias; Restless Legs Syndrome; Sleep; Sleep Wake Disorders
PubMed: 33145749
DOI: 10.33588/rn.7110.2020365 -
Sleep Jun 2023Isolated rapid eye movement sleep behavior disorder (iRBD) is a parasomnia characterized by dream enactment. It represents a prodromal state of α-synucleinopathies,... (Review)
Review
STUDY OBJECTIVES
Isolated rapid eye movement sleep behavior disorder (iRBD) is a parasomnia characterized by dream enactment. It represents a prodromal state of α-synucleinopathies, like Parkinson's disease. In recent years, biomarkers of increased risk of phenoconversion from iRBD to overt α-synucleinopathies have been identified. Currently, diagnosis and monitoring rely on self-reported reports and polysomnography (PSG) performed in the sleep lab, which is limited in availability and cost-intensive. Wearable technologies and computerized algorithms may provide comfortable and cost-efficient means to not only improve the identification of patients with iRBD but also to monitor risk factors of phenoconversion. In this work, we review studies using these technologies to identify iRBD or monitor phenoconversion biomarkers.
METHODS
A review of articles published until May 31, 2022 using the Medline database was performed. We included only papers in which participants with RBD were part of the study population. The selected papers were divided into four sessions: actigraphy, gait analysis systems, computerized algorithms, and novel technologies.
RESULTS
In total, 25 articles were included in the review. Actigraphy, wearable accelerometers, pressure mats, smartphones, tablets, and algorithms based on PSG signals were used to identify RBD and monitor the phenoconversion. Rest-activity patterns, core body temperature, gait, and sleep parameters were able to identify the different stages of the disease.
CONCLUSIONS
These tools may complement current diagnostic systems in the future, providing objective ambulatory data obtained comfortably and inexpensively. Consequently, screening for iRBD and follow-up will be more accessible for the concerned patient cohort.
Topics: Humans; REM Sleep Behavior Disorder; Synucleinopathies; Parkinson Disease; Polysomnography; Biomarkers
PubMed: 36789541
DOI: 10.1093/sleep/zsad030 -
Annals of the Academy of Medicine,... Apr 2022In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but... (Review)
Review
INTRODUCTION
In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours.
METHODS
This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias.
RESULTS
Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area.
CONCLUSION
NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
Topics: Adult; Humans; Parasomnias; Singapore; Sleep; Somnambulism
PubMed: 35506406
DOI: 10.47102/annals-acadmedsg.2021449 -
Journal of Clinical Sleep Medicine :... Mar 2019Sexsomnia has been reported and is well described in 115 prior cases in the literature. There have been associations with other sleep disorders serving as triggers for...
Sexsomnia has been reported and is well described in 115 prior cases in the literature. There have been associations with other sleep disorders serving as triggers for confusional arousals, thereby worsening sexsomnia episodes. We present a case of an adolescent boy with a history of resected and treated pineoblastoma who later developed sexsomnia marked by multiple episodes of masturbatory events per night. He had additional suspicions of obstructive sleep apnea. Polysomnography confirmed severe obstructive sleep apnea and captured multiple episodes of sexsomnia from both REM and NREM sleep. The patient also had daytime symptoms of severe anxiety and hypersomnia that required pharmacological intervention, cognitive behavioral techniques, and hypnosis. The patient showed improvement with hypnosis along with a multimodal approach to the treatment of sexsomnia.
Topics: Adolescent; Humans; Male; Masturbation; Parasomnias; Polysomnography; Sleep Apnea, Obstructive; Sleep Arousal Disorders; Sleep Stages
PubMed: 30853039
DOI: 10.5664/jcsm.7686 -
European Journal of Medical Genetics Jun 2023Early onset sleep problems and disorders are very common in individuals with Phelan-McDermid Syndrome (PMS) with rates of up to 90%. These sleep problems and disorders... (Review)
Review
Early onset sleep problems and disorders are very common in individuals with Phelan-McDermid Syndrome (PMS) with rates of up to 90%. These sleep problems and disorders cannot be taken lightly. Not only do they have a major impact on the health, behaviour, functioning and learning opportunities of affected individuals, they can also have detrimental effects on the well-being and resilience of parents and caregivers, ultimately affecting the physical health, mental health and well-being of the whole social system. In this review we aim to understand the types and frequencies of sleeping problems in PMS as the basis for recommendations on their management and treatment and to provide general guidelines for clinicians and practitioners. We conducted an in-depth literature search, summarised findings, and participated in a series of consensus meetings with other consortium members - experts on PMS and stakeholders - to agree on guidelines and recommendations. In parallel, a world-wide survey was created and distributed amongst parents to include their perspective. Our literature search found only four articles specifically focused on sleeping problems in PMS, although some other articles mentioned prevalence and associated factors. Country-specific prevalence rates ranged between 24% and 46%, whereas our parental survey reported 59%. The main problems reported involved difficulty falling asleep and numerous night awakenings, with being restless in sleep, night-time incontinence, and tooth grinding also commonly reported. Only a small number of individuals had undergone a sleep study monitored by a specialist. Bedtime resistance normally decreases with age, but sleep-onset delay, sleep anxiety, parasomnias, problems falling and remaining asleep remain throughout lifespan, with total sleep time improving during adulthood. However, this improvement was also accompanied by a substantial increase in parasomnias. Ultimately, an increase in sleep disorders in children correlates with increased sleep disorders and daytime sleepiness in parents/caregivers. No study to date has focused on the underlying causes of sleeping problems in PMS, but comorbid mental health conditions, somatic causes, or (poly)pharmacy have been proposed as triggers for sleeping disturbances. Currently there is no PMS-specific treatment for sleeping problems, and current recommendations are mostly based on individuals with intellectual disability and/or neurodevelopmental conditions.
Topics: Child; Humans; Adult; Consensus; Chromosome Disorders; Sleep Wake Disorders; Parasomnias
PubMed: 36963463
DOI: 10.1016/j.ejmg.2023.104750 -
Current Opinion in Neurology Aug 2017Review of the literature pertaining to clinical presentation, classification, epidemiology, pathophysiology, diagnosis, and treatment of sleep-related movement disorders... (Review)
Review
PURPOSE OF REVIEW
Review of the literature pertaining to clinical presentation, classification, epidemiology, pathophysiology, diagnosis, and treatment of sleep-related movement disorders and disturbances of motor control.
RECENT FINDINGS
Sleep-related movement disorders and disturbances of motor control are typically characterized by positive motor symptoms and are often associated with sleep disturbances and consequent daytime symptoms (e.g. fatigue, sleepiness). They often represent the first or main manifestation of underlying disorders of the central nervous system, which require specific work-up and treatment. Diverse and often combined cause factors have been identified. Although recent data provide some evidence regarding abnormal activation and/or disinhibition of motor circuits during sleep, for the majority of these disorders the pathogenetic mechanisms remain speculative. The differential diagnosis is sometimes difficult and misdiagnoses are not infrequent. The diagnosis is based on clinical and video-polysomnographic findings. Treatment of sleep-related motor disturbances with few exceptions (e.g. restless legs/limbs syndrome) are based mainly on anecdotal reports or small series.
SUMMARY
More state-of-the-art studies on the cause, pathophysiology, and treatment of sleep-related movement disorders and disturbances of motor control are needed.
Topics: Humans; Movement Disorders; Nocturnal Myoclonus Syndrome; Restless Legs Syndrome; Sleep Wake Disorders
PubMed: 28582324
DOI: 10.1097/WCO.0000000000000466 -
Medicina 2018Non-epileptic paroxysmal disorders are frequent events in the neonate, generally transient. However, due to their intensity they can be confused as true epileptic... (Review)
Review
Non-epileptic paroxysmal disorders are frequent events in the neonate, generally transient. However, due to their intensity they can be confused as true epileptic seizures. The objective of this review is to update the concepts in relation to tremors, neonatal benign sleep myoclonus (MNBS) and hyperekplexia. The tremors are very frequent, once identified it must be determined if they belong to a hyperexcitability syndrome related to maternal or perinatal factors, in idiopathic cases a good prognosis is expected. MNBS are often confused with epileptic seizures. They are characterized by the fact that myoclonus is brief and occurs only in sleep, children are normal, and the EEG is also normal. Hyperekplexia is a rare, genetically determined disorder characterized by hypertonia and exaggerated startle reactions to a banal stimulus, which can be improved with clonazepam.
Topics: Diagnosis, Differential; Electroencephalography; Epilepsy; Humans; Hyperekplexia; Infant, Newborn; Parasomnias; Seizures
PubMed: 30199364
DOI: No ID Found -
Journal of Clinical Sleep Medicine :... Mar 2023This pilot study determined whether transdiagnostic cognitive behavioral therapy for parasomnias (CBTp) reduces parasomnia and activity levels during sleep in a sample... (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY OBJECTIVES
This pilot study determined whether transdiagnostic cognitive behavioral therapy for parasomnias (CBTp) reduces parasomnia and activity levels during sleep in a sample of adult sleep clinic outpatients. A secondary objective was to assess whether treatment produces improvements in daytime fatigue/sleepiness, perceived cognition, mood, and depression/anxiety/stress, as well as functional impairment in work and leisure activities.
METHODS
This was a randomized controlled trial with CBTp and self-monitoring control conditions. Participants were 19 adults with a DSM 5 parasomnia disorder who received individual CBTp virtually from their homes. CBTp consisted of psychoeducation, sleep hygiene and safety instructions, relaxation training, parasomnia techniques, and relapse prevention in a 6-week manualized, structured program.
RESULTS
Using a repeated measures analysis of variance model, and relative to a self-monitoring control condition, results showed that CBTp produced statistically significant improvements in parasomnia frequency, severity, nocturnal activity, and sleep efficiency. There was a trend toward reduced sleep-onset latency and improved work and social adjustment. Of treated participants, 100% rated themselves as improved at study conclusion.
CONCLUSIONS
Implications of these findings are that cognitive behavioral interventions for parasomnias are effective in lessening parasomnias. More investigation into this type of treatment is warranted.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Impact of Cognitive Behavioral Therapy on Parasomnias; URL: https://clinicaltrials.gov/ct2/show/NCT04633668; Identifier: NCT04633668.
CITATION
Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. . 2023;19(3):499-509.
Topics: Adult; Humans; Dreams; Pilot Projects; Polysomnography; Parasomnias; Cognitive Behavioral Therapy; Disorders of Excessive Somnolence
PubMed: 36468650
DOI: 10.5664/jcsm.10374 -
Australian Family Physician 2017Sleepwalking is a relatively common and innocuous arousal disorder during non‑rapid eye movement sleep. (Review)
Review
BACKGROUND
Sleepwalking is a relatively common and innocuous arousal disorder during non‑rapid eye movement sleep.
OBJECTIVE
This paper provides a review of the most recent science on sleepwalking to guide clinical decision-making.
DISCUSSION
Most patients who sleepwalk do not require treatment, but comorbid sleep disorders that result in daytime tiredness, and behaviour and emotional problems require assessment and interventions. In the absence of clinical trials, tentative, low-risk treatments - scheduled waking and hypnosis - are suggested for sleepwalking that results in distress or violence towards others. People who sleepwalk and are violent may benefit from impulse-control interventions.
Topics: Adolescent; Child; Fatigue; Humans; Somnambulism
PubMed: 28787563
DOI: No ID Found