Propriospinal myoclonus at sleep onset causing severe insomnia: A polysomnographic and electromyographic analysis

Khoo, See Meng; Tan, Joo Hui; Shi, Dong Xia; Jamil, Hajjah Khalizah Haji; Rajendran, N.; Tk, Lim

doi:10.1016/j.sleep.2008.09.012

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…No guidelines are available regarding treatment of true PSM at sleep onset. Single reports or case series reported amelioration of symptoms on treatment with clonazepam [ 36 – 38 ]. Valproate, zonisamide, levetiracetam, and opioids may improve symptoms in single cases [ 31 •, 32 •, 36 ].…”

Section: Propriospinal Myoclonus At Sleep Onsetmentioning

confidence: 99%

Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep

Stefani

Högl

2019

Curr Treat Options Neurol

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Purpose of reviewSleep-related movement disorders (SRMD) include several different motor activities during sleep. Few of them are well known and well classified, whereas others are minor motor disorders of sleep which are neither thoroughly characterized and classified nor have been extensively investigated to clarify their pathogenesis and clinical relevance. This review will focus on those minor sleep-related movement disorders.Recent findingsBefore diagnosing periodic limb movement (PLM) disorder in patients with PLM during polysomnography, other disorders associated with PLM need to be excluded, namely restless legs syndrome (RLS), narcolepsy, REM sleep behavior disorder (RBD), and sleep-related breathing disorder. For the diagnosis of propriospinal myoclonus at sleep-onset, multi-channel surface electromyography recording during polysomnography is required and a possible psychogenic origin of the movement disorder has to be considered. Excessive fragmentary myoclonus (EFM) does not require symptomatic treatment, but further evaluation is suggested as electrophysiological abnormalities are present in 50% of cases. Nine percent of healthy sleepers meet the criteria for EFM, raising the question if current, arbitrarily defined, cutoffs are valid. Hypnagogic foot tremor, rhythmic feet movements, alternating leg muscle activation, and high-frequency leg movements are somewhat overlapping minor motor activities during sleep which may exist on their own or represent stereotyped movements to relieve RLS-like symptoms. Neck myoclonus is probably a physiological phenomenon related to REM twitching. RBD is formally a parasomnia but a relevant differential diagnosis when evaluating sleep-related movement disorders. In particular, prodromal RBD is characterized by electromyographic and behavioral findings on video-polysomnography which needs to be differentiated by minor sleep-related movement disorders.SummaryMinor SRMD beyond the well-known main motor disorders of sleep should be correctly diagnosed, distinguished from differential diagnosis, and understood in their potential clinical relevance, in order also to start an appropriate treatment if needed.

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Section: Propriospinal Myoclonus At Sleep Onsetmentioning

confidence: 99%

Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep

Stefani

Högl

2019

Curr Treat Options Neurol

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“…PSM at sleep onset PSM worsening at sleep onset was first reported by sleep medicine experts [3,4,22,24,35,39], but also in other case-reports and cohort studies [19,28,36,37,43,44]. Indeed, it seems to be a peculiar feature of PSM even if it is not always reported, probably because clinicians do not always ask specifically about this feature [37].…”

Section: Bpmentioning

confidence: 96%

“…Due to its independent clinical, neuropsychological and neurometabolic characteristics [50], this state seems to act as a pacemaker for many movement disorders besides PSM, i.e., rhythmic body movements, hypnic jerks and restless legs syndrome (RLS). Studies with full night video-PSG recordings showed that PSM appears only at sleepewake transition (stage 1 of NREM sleep), while it quickly disappears with stage 2 of NREM sleep onset [4, 19,22,24,43,44]. A few studies have documented the persistence of the jerks during sleep [1, 31,35,40], However, it is still not clear which underlying factor allows the jerks to persist during sleep.…”

Section: Bpmentioning

confidence: 99%

Propriospinal myoclonus: The spectrum of clinical and neurophysiological phenotypes

Antelmi¹,

Provini²

2015

Sleep Medicine Reviews

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“…The uncommon features of this case include focal myoclonic activity in the axial muscles during stable sleep and later progression into a myoclonic status indicating a very high spinal cord excitability. Recently, a case of PSM at sleep onset was described in an Asian woman from Singapore [41]. The pathophysiological mechanism of PSM at wake-sleep transition stage (predormitum as suggested by Critchley [42]) is hypothesized to be due to the lack of supraspinal inhibitory control at this stage, with resultant spinal cord hyperexcitability propagated through propriospinal pathways [37,38].…”

Section: Pathologicalmentioning

confidence: 99%

Movement Disorders in Sleep

Chokroverty

Bhat

2015

Sleep Medicine

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Propriospinal myoclonus at sleep onset causing severe insomnia: A polysomnographic and electromyographic analysis

Cited by 6 publications

References 2 publications

Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep

Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep

Propriospinal myoclonus: The spectrum of clinical and neurophysiological phenotypes

Movement Disorders in Sleep

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