Status dissociatus: the most extreme expression of state dissociation

Miró-Andreu, A.; López-Bernabé, Roberto; Sánchez, Mariana; Sardiña, M.C. Maeztu

doi:10.1016/j.nrleng.2019.02.002

Cited by 2 publications

(6 citation statements)

References 10 publications

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“…The PSG demonstrated admixtures of various markers of different sleep stages occurring simultaneously, suggesting breakdown of the boundaries between distinct sleep states. Clinically patient appeared to be asleep but would demonstrate complex motor behavior suggestive of dream enactment [114]. This phenomenon has been noted in conditions such as alcohol withdrawal state, narcolepsy, autoimmune encephalititis, Iglon-5 parasomnia, fatal familial insomnia, and alpha synuclein disorders [90,115].…”

Section: Status Dissociatusmentioning

confidence: 93%

NonREM Disorders of Arousal and Related Parasomnias: an Updated Review

2021

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Parasomnias are abnormal behaviors and/or experiences emanating from or associated with sleep typically manifesting as motor movements of varying semiology. We discuss mainly nonrapid eye movement sleep and related parasomnias in this article. Sleepwalking (SW), sleep terrors (ST), confusional arousals, and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, and/or promote sleep inertia, lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications, in particular the widely prescribed benzodiazepine receptor agonists. Compelling evidence suggests that nocturnal eating may in some cases be another nonmotor manifestation of Restless Legs Syndrome (RLS). Initial management should focus upon decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders and eliminating incriminating drugs. Sexsomnia is a subtype of disorders of arousal, where sexual behavior emerges from partial arousal from nonREM sleep. Overlap parasomnia disorders consist of abnormal sleep-related behavior both in nonREM and REM sleep. Status dissociatus is referred to as a breakdown of the sleep architecture where an admixture of various sleep state markers is seen without any specific demarcation. Benzodiazepine therapy can be effective in controlling SW, ST, and sexsomnia, but not SRED. Paroxetine has been reported to provide benefit in some cases of ST. Topiramate, pramipexole, and sertraline can be effective in SRED. Pharmacotherapy for other parasomnias continues to be less certain, necessitating further investigation. NREM parasomnias may resolve spontaneously but require a review of priming and predisposing factors.

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Section: Status Dissociatusmentioning

confidence: 93%

NonREM Disorders of Arousal and Related Parasomnias: an Updated Review

2021

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“…56,58,59,63 In a representative case of Morvan syndrome, the patient would hit and punch his wife while sleeping, fall from bed, sleep talk. 58 His video PSG showed severely fragmented sleep with sleep composed of short periods of NREM 1 and REM sleep without atonia and no NREM 2 or NREM 3 sleep. Continuous motor hyperactivity (with simple flexion-extension movements of all limbs and continuous changes in body position), dream enactment behaviors, confusional arousals, and sleep talking were observed when sleeping.…”

Section: Caspr2 Antibodies Associated With Limbic Encephalitis and Mo...mentioning

confidence: 99%

Section: Swds Especially Common In Particular Autoimmune Encephalitidesmentioning

confidence: 99%

“…Twenty-four hour video PSG recordings in patients with Morvan syndrome show very disorganized sleep/wake patterns with loss of circadian rhythmicity, reduced/absent sleep spindles and K-complexes, brief periods of NREM 3, intrusions, brief fragments of REM sleep, REM sleep without atonia, and rapid shifts between wakefulness, NREM, and REM sleep (later usually without atonia). 56,58,59,63…”

Section: Swds Especially Common In Particular Autoimmune Encephalitidesmentioning

confidence: 99%

“…48,56,57 As the disease progresses, circadian rhythms are lost and distinctions between wakefulness, NREM, and REM sleep blur (termed status dissociatus) and prolonged dream enactment behaviors and hallucinations (called by some oneiric stupor) occur. [58][59][60][61][62] Video PSG recordings in patients with Morvan syndrome show them performing simple and complex behaviors mimicking daily life behaviors (such as eating, dressing, buttoning pajamas). 62,63 When severe, patients exhibit nearly continuous dream enactment behaviors, which can emerge from relaxed wakefulness, REM, or NREM sleep.…”

Section: Caspr2 Antibodies Associated With Limbic Encephalitis and Mo...mentioning

confidence: 99%

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Recognizing New-Onset Sleep Disorders in Autoimmune Encephalitis Often Prompt Earlier Diagnosis

Ralls¹,

Cutchen

Grigg-Damberger

2022

Journal of Clinical Neurophysiology

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Summary:Sleep/wake disorders are common in patients with autoimmune encephalitis, sometimes the most prominent or sole initial symptom, then delaying diagnosis. Sleep/wake disorders in autoimmune encephalitis vary and include severe sleeplessness, hypersomnia, central and/or obstructive sleep apnea, rapid eye movement sleep behavior disorder, indeterminate sleep/wake states, and loss of circadian sleep/wake rhythms. N-methyl-d aspartate receptor encephalitis (NMDAR) is often associated with insomnia, then hypersomnia and sleep-related central hypoventilation. Profound sleeplessness and rapid eye movement sleep behavior disorder are seen in patients with voltage-gated potassium channel–complex antibodies. Fragmented sleep and hypersomnia are common in paraneoplastic syndromes associated with anti-MA protein encephalitis; rapid eye movement sleep behavior disorder in those with antibodies against leucine-rich glioma inactivated protein (LGI1) or contactin-associated protein 2 (CASPR2) antibodies. Antibodies against a cell adhesion protein IGLON5 may result in obstructive sleep apnea, inspiratory stridor, disorganized nonrapid eye movement sleep, and excessive movements and parasomnias fragmenting nonrapid and rapid eye movement sleep. Recognizing a particular sleep/wake disorder is often a presenting or prominent feature in certain autoimmune encephalitis permit for earlier diagnosis. This is important because reduced morbidity and better short- and long-term outcomes are associated with earlier diagnosis and immunotherapies.

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Status dissociatus: the most extreme expression of state dissociation

Cited by 2 publications

References 10 publications

NonREM Disorders of Arousal and Related Parasomnias: an Updated Review

NonREM Disorders of Arousal and Related Parasomnias: an Updated Review

Recognizing New-Onset Sleep Disorders in Autoimmune Encephalitis Often Prompt Earlier Diagnosis

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