Excessive fragmentary myoclonus in patients with Parkinson’s disease: prevalence and clinico-polysomnographic profile

Sobreira-Neto, Manoel Alves; Pena-Pereira, Márcio Alexandre; Sobreira, Emmanuelle Silva Tavares; Chagas, Marcos Hortes Nisihara; Tumas, Vítor; Fernandes, Regina Maria França; Éckeli, Alan Luiz

doi:10.1007/s11325-014-1098-2

Cited by 10 publications

(10 citation statements)

References 15 publications

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“…The hypothesis that brainstem is the site of origin of EFM is moreover supported by reports of the occurrence of EFM in neurodegenerative diseases associated with the lesions of the brainstem structures (Vankova et al, 2003;Pincherle et al, 2006;Vetrugno et al, 2007;dos Santos et al, 2014;Sobreira-Neto et al, 2015).…”

Section: Neurophysiologymentioning

confidence: 82%

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Excessive Fragmentary Myoclonus: What Do We Know?

Nepožitek

Šonka

2017

Prague Med. Rep.

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Abstract:Excessive fragmentary myoclonus (EFM) is a polysomnographic finding registered by the surface electromyography (EMG) and characterized as a result of the muscle activity consisting of sudden, isolated, arrhythmic, asynchronous and asymmetric brief twitches. The EMG potentials are defined by the exact criteria in The International Classification of the Sleep Disorders, 3 rd edition and they appear with high intensity in all sleep stages. Clinical significance of EFM is unclear. It was observed in combination with other diseases and features such as obstructive and central sleep apnea, narcolepsy, periodic limb movements, insomnia, neurodegenerative disorders and peripheral nerve dysfunction. Relation to such wide range of diseases supports the opinion that EFM is nor a specific sleep disorder nor a specific polysomnographic sign. The option that EFM is a normal variant has also not been ruled out so far.

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Section: Neurophysiologymentioning

confidence: 82%

“…The EFM was observed in Parkinson's disease (Sobreira-Neto et al, 2015), multiple system atrophy (Vetrugno et al, 2007), amyotrophic lateral sclerosis (Sonka et al, 2004), Machado-Joseph disease (dos Santos et al, 2014), NiemannPick disease type C (Vankova et al, 2003) and mitochondrial encephalopathy (Pincherle et al, 2006).…”

Section: Clinical Significancementioning

confidence: 99%

Excessive Fragmentary Myoclonus: What Do We Know?

Nepožitek

Šonka

2017

Prague Med. Rep.

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“…At the same time, the algorithm made more errors in distinguishing RBD(−)PLMS(−) from RBD(−)PLMS(+) in PD(+) compared to PD(−) participants. This might be caused by the fact that PD(+) patients may present a variety of abnormal MEs during sleep, such as excessive fragmentary myoclonus (Sobreira‐Neto et al., ), which also in this case might confound the automated classification.…”

Section: Discussionmentioning

confidence: 99%

External validation of a data‐driven algorithm for muscular activity identification during sleep

Cesari

Christensen

Sørensen

et al. 2019

Journal of Sleep Research

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Several automated methods for scoring periodic limb movements during sleep (PLMS) and rapid eye movement (REM) sleep without atonia (RSWA) have been proposed, but most of them were developed and validated on data recorded in the same clinic, thus they may be biased. This work aims to validate our data‐driven algorithm for muscular activity detection during sleep, originally developed based on data recorded and manually scored at the Danish Center for Sleep Medicine. The validation was carried out on a cohort of 240 participants, including de novo Parkinson's disease (PD) patients and neurologically healthy controls, whose sleep data were recorded and manually evaluated at Paracelsus‐Elena Klinik, Kassel, Germany. In the German cohort, the algorithm showed generally good agreement between manual and automated PLMS indices, and identified with 88.75% accuracy participants with PLMS index above 15 PLMS per hour of sleep, and with 84.17% accuracy patients suffering from REM sleep behaviour disorder (RBD) showing RSWA. By comparing the algorithm performances in the Danish and German cohorts, we hypothesized that inter‐clinical differences may exist in the way limb movements are manually scored and how healthy controls are defined. Finally, the algorithm performed worse in PD patients, probably as a result of increased artefacts caused by abnormal motor events related to neurodegeneration. Our algorithm can identify, with reasonable performance, participants with RBD and increased PLMS index from data recorded in different centres, and its application may reveal inter clinical differences, which can be overcome in the future by applying automated methods.

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“…Although EFM is described as a benign movement phenomenon [24], recent studies suggest an association with Parkinson's disease [35] and with peripheral nerve pathologies [36 & ]. The diagnosis is based on the presence of characteristic EMG pattern of at least 150 ms, in at least 20 min of NREM sleep, and a rate of five EMG EFM potentials per minute, during polysomnography.…”

Section: Excessive Fragmentary Myoclonusmentioning

confidence: 99%

Sleep-related movement disorders and disturbances of motor control

Bargiotas

Bassetti²

2017

Current Opinion in Neurology

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Purpose of reviewReview of the literature pertaining to clinical presentation, classification, epidemiology, pathophysiology, diagnosis, and treatment of sleep-related movement disorders and disturbances of motor control. Recent findingsSleep-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 sleeprelated motor disturbances with few exceptions (e.g. restless legs/limbs syndrome) are based mainly on anecdotal reports or small series. SummaryMore state-of-the-art studies on the cause, pathophysiology, and treatment of sleep-related movement disorders and disturbances of motor control are needed.

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Excessive fragmentary myoclonus in patients with Parkinson’s disease: prevalence and clinico-polysomnographic profile

Abstract: EFM occurs in a significantly high proportion of PD patients and is related to obstructive sleep apnea syndrome (OSAS) and advanced age, so EFM should be systematically investigated by polysomnography (PSG) in PD patients.

Cited by 10 publications

References 15 publications

Excessive Fragmentary Myoclonus: What Do We Know?

Excessive Fragmentary Myoclonus: What Do We Know?

External validation of a data‐driven algorithm for muscular activity identification during sleep

Sleep-related movement disorders and disturbances of motor control

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