Cassette EEG Sleep Recordings in Gilles de la Tourette Syndrome

Abstract

Tourette syndrome (TS) patients often complain of sleep problems, and questionnaire studies indicate that sleep disturbance is frequent. Decreased slow wave sleep and increased awakenings have been reported in laboratory polysomnography in TS patients, and a serotoninergic disorder of arousal has been postulated. We recorded outpatient sleep in 20 patients newly diagnosed with TS utilizing a 4-channel cassette EEG system. The newly-diagnosed patients were predominantly male, and ranged in age from 10 to 36 years. Some had taken psychotropic medications in the past, but none had been treated systematically for TS. Seven patients had chronic tics only, 8 had tics and attention deficit-hyperactivity, and 5 had tics plus obsessions and compulsions. None had other medical, neurologic, or psychiatric disorders. All were nocturnal sleepers, and were recorded in their usual sleeping environments and routines. TS patients had reduced sleep, decreased sleep efficiency, increased awakenings, and decreased slow wave sleep. Tic patients had increased nocturnal awakenings and movements, particularly those who had tics during sleep. Sleep fragmentation and loss of slow wave sleep was most marked in TS patients with attention deficit-hyperactivity. Sleep latency was increased, REM sleep reduced, and REM sleep latency decreased in TS patients with obsessions and compulsions. These findings accord with previous reports of sleep disturbance in TS, and suggest that these disturbances may vary with TS symptoms. Chronic tics may persist in sleep and cause awakenings, TS with attention deficit may be associated with a disorder of arousal and alertness, and obsessions and compulsions may be manifestations of a biochemical disturbance involving paradoxical sleep.

Neurobiology of the Premonitory Urge in Tourette’s Syndrome: Pathophysiology and Treatment Implications

“…Van der Salm et al {99} found that patients with psychogenic jerks have a readiness potential prior to their movements significantly more often and with a significantly earlier onset than patients with TS. Finally, although tics are considerably less frequent during sleep, they have been observed during all phases of sleep, including slow wave sleep {100}, suggesting that at least some tics are involuntary.…”

Decreased sleep quality and increased sleep related movements in patients with Tourette's syndrome

“…Conflicting results have been reported concerning an unaffected3 4 or decreased5 6sleep efficiency, unaffected3 4 or prolonged6 sleep latency, increased,4decreased3 6 or unaffected5 slow wave sleep, and reduced1 4 6 or unaffected3 5 7 rapid eye movement (REM) sleep. No data exist about the influence of Tourette's syndrome severity on objective sleep parameters.…”

REM Sleep Behaviour Disorder in a Child with Tourette's Syndrome

“…In cases such as this, one should expect complex sleep pathology, including presence of tics (reportedly present in 20% of patients with To u r e t t e 's syndrome 5 ) and (periodic) leg movements in sleep, as well as REM or non-REM sleep parasomnia, which were all present in our patient. T h e combination of REM and non-REM parasomnia has been previously documented, 2 4 warranting careful clinical and polysomnographic examination before one draws definite conclusions.…”