Relationship of Periodic Movements in Sleep (Nocturnal Myoclonus) and the Babinski Sign

Smith, Robert C.

doi:10.1093/sleep/8.3.239

Cited by 71 publications

(16 citation statements)

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“…The polysynaptic Babinski reflex that emerges with interruption of the descending pyramidal tracts has been identified by Smith as one possible candidate in this theory, particularly since PLM's closely resemble the "triple flexion" elicited in the Babinski maneuver. 19 Yokota et al reported their observations of PLMD in 10 patients with spinal cord disease including multiple sclerosis (MS), cervical spondylosis, spinal cord injury, and spinal cord infarction. 14 Two patients exhibited PLMD despite complete spinal cord transection, and two patients with MS demonstrated waxing and waning of the PLMD along with the degree of their myelopathy, leading the authors to conclude that PLMD can originate from a spinal generator.…”

Section: Discussionmentioning

confidence: 99%

Transverse Myelitis Associated with Restless Legs Syndrome and Periodic Movements of Sleep Responsive to an Oral Dopaminergic Agent But Not to Intrathecal Baclofen

Brown

Heffner

Obbens

2000

Sleep

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, most commonly consisting of dorsiflexion at the ankle and extension of the big toe and sometimes accompanied by flexion of the knee and/or hip. 1,2 Restless legs syndrome (RLS) is frequently accompanied by PLMD, and is defined clinically as an irresistible need to move the legs in order to relieve a dysesthesia, often resulting in symptoms of insomnia. Periodic limb movement disorder not complicated by RLS may possibly result in nocturnal awakenings or daytime sleepiness, but is now increasingly recognized as an incidental, asymptomatic finding. [3][4][5] Since PLMD occurs in the majority of patients with RLS and both conditions are treated with similar medications, they may represent different clinical manifestations of the same central nervous system (CNS) pathology. 2 Both disorders are more prevalent in patients with spinal cord disease. 2 Enhancement of CNS dopaminergic and opioid activity can effectively treat RLS/PLMD. 2 Baclofen, an inhibitor of spinal cord reflexes utilized as an antispasmodic, has also been used in RLS/PLMD with varying success. [6][7][8] In this paper we report the unusual association of RLS/PLMD with acute (presumed viral) transverse myelitis. In addition, RLS/PLMD occurred in this patient despite treatment with intrathecal baclofen, while the dopaminergic agent pergolide provided symptomatic relief. Case ReportA 45-year-old man complained of frequent nighttime awakenings and unrefreshing sleep. He had contracted infectious mononucleosis 25 years previously, complicated by quadriparesis and respiratory failure requiring tracheotomy and ventilatory support for three months. Ebstein-Barr serologies were not available at the time of his illness. Although an initial diagnosis of Guillain Barré syndrome was entertained, acute transverse myelitis was felt to be more likely given his initial presentation with urinary retention and the rapid development of a clear cut level of sensory deficit. Later findings of lower extremity spastic paraparesis, hyperreflexia, positive Babinski reflexes, and neurogenic bladder supported the diagnosis of transverse myelitis at a mid-thoracic level. Despite oral baclofen started seven years after his acute illness, and placement of a posterior column stimulator three years later, spasticity progressed leaving him wheelchair-bound. Continuous intrathecal baclofen (1204 mcg/day), initiated seven years later, produced substantial improvement in spasticity that has continued to the present despite removal of the posterior column stimulator.The patient had been awakening five to six times per night for the past five to ten years. Half of the awakenings were associated with nocturia due to neurogenic bladder, Abstract: Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are related sleep disorders that occur with increased frequency in spinal cord disease. Effective treatment may be obtained with dopaminergic or opioid drugs, while anticonvulsants, benzodiazepines, and possibly baclofen may be helpful. This report describes a patient who deve...

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Section: Discussionmentioning

confidence: 99%

Transverse Myelitis Associated with Restless Legs Syndrome and Periodic Movements of Sleep Responsive to an Oral Dopaminergic Agent But Not to Intrathecal Baclofen

Brown

Heffner

Obbens

2000

Sleep

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“…PLMS were well characterized by Smith 5 , who commented on its similarity with the Babinski sign. In most patients, there is active dorsiflexion of the ankle, dorsiflexion and fanning of the small toes, and dorsiflexion of the great toe.…”

Section: Discussionmentioning

confidence: 99%

“…In most patients, there is active dorsiflexion of the ankle, dorsiflexion and fanning of the small toes, and dorsiflexion of the great toe. Partial flexion of the knee and hip may occur in one quarter of the patie n t s 5 . Dopaminergic agents such as dopamine agonists and levodopa/dopa decarboxylase inhibitors are c o n s i d e red the treatment of choice for RLS-re l a t e d PLMS 3 .…”

Section: Discussionmentioning

confidence: 99%

Botulinum-A toxin in the treatment of painful post-stroke nocturnal paroxysmal dystonia triggered by periodic limb movements of sleep: case report

Kowacs

Teive

Piovesan

et al. 2006

Arq. Neuro-Psiquiatr.

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-I n t roduction: Sleep disorders presenting involuntary movements may be very annoying to patients, apart from their negative influence on sleep. Objective: To re p o rt the use of botulinum type-A toxin (BoNT-A) to manage the case of a patient whose sleep was severely disrupted by episodes of dystonic posturing of the right lower limb triggered by periodic limb movements of sleep (PLMS). Method: A 79-year-old woman with mild post-stroke right hemiparesis presented with re c u rrent painful episodes of dystonia of the right lower limb, which disrupted her sleep. The dystonic episodes could also be voluntarily triggered by extension of the right hallux. Polysomnography confirmed that the dystonic episodes w e re triggered by PLMS. Twenty units of BoNT-A (20U/500U vial) were injected into her right extensor hallucis longus. Results: Shortly after BoNT-A was injected, the dystonic symptoms abated, and the patient achieved better sleep eff i c i e n c y. Conclusion: The PLMS-related involuntary extension of the hallux was p robably triggering the nocturnal post-stroke lower limb dystonic paroxysms. BoNT-A injection into the right extensor hallucis longus was effective in managing this condition and thus resolved the associated disruption of sleep.KEY WORDS: botulinum toxin-A, dystonia, post-stroke dystonia, periodic movements of sleep.Toxina botulínica tipo A no tratamento da distonia paroxística noturna dolorosa pós-isquemia cerebral desencadeada por movimentos periódicos do sono: relato de caso RESUMO -I n t rodução: D e s o rdens do sono apresentando movimentos involuntários podem ser bastante p e rturbadoras aos pacientes, além de sua influência negativa no sono. Objetivo: D e s c rever o uso da toxina botulínica tipo-A (BoNT-A) no manejo do caso de um paciente cujo sono estava gravemente fragmentado por episódios de distonia do membro inferior direito, desencadeados por movimentos periódicos do sono (MPS). Método: Uma paciente com 79 anos portadora de hemiparesia direita leve seqüelar a isquemia c e rebral (AVCI) pro c u rou-nos por episódios dolorosos re c o rrentes de distonia noturna de seu membro inferior direito, os quais fragmentavam seu sono. Os episódios de distonia também podiam ser desencadeados voluntariamente, por extensão do hálux direito. Uma polisonografia confirmou que os episódios distônicos eram desencadeados pelos MPS. Vinte unidades de BoNT-A (20 U/frasco de 500 U) foram injetadas no seu extensor longo do hálux. Resultados: Alguns dias após a injeção de BoNT-A os sintomas distôni-cos re g rediram, e o sono da paciente tornou-se eficiente. Conclusão: As extensões involuntárias do hálux relacionadas aos movimentos periódicos do sono estavam provavelmente desencadeando os paro x i s m o s distônicos noturnos pós-AVCI. A injeção de BoNT-A no extensor longo do hálux foi eficaz no manejo desta condição, resolvedo assim a fragmentação do sono. PALAVRAS-CHAVE: toxina botulínica tipo-A, distonia, distonia pós-AVC, movimentos periódicos do sono.

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“…Classic clinical reports have characterized these movements as a partial or complete “triple flexion” response, with extension of the great toe, dorsiflexion of the ankle, and occasional flexion of the knee and hip [36]. The movements, however, can often be more vigorous, causing significant disruption to a bed partner’s sleep.…”

Section: Periodic Limb Movement Disorder and Its Pharmacologic Managementioning

confidence: 99%

Behavioral Sleep Medicine Interventions for Restless Legs Syndrome and Periodic Limb Movement Disorder

Pigeon

Yurcheshen

2009

Sleep Medicine Clinics

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SYNOPSIS Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) are sleep disorders that are commonly seen in clinical practice. The standard treatment recommendations for these disorders are pharmacologic; most recently both conditions are most typically managed with pramipexole or ropinerole, which are FDA approved for the treatment of RLS. A mix of behavioral suggestions is included in treatment algorithms for providers as well as in patient education materials. While these suggestions have considerable merit, they are typically not delivered as an intervention, but instead provided as a series of helpful tips. There is emerging evidence for providing such suggestions as a more active and comprehensive intervention as part of a cognitive-behavioral package as well as for exercise therapy and cognitive behavioral therapy for insomnia to be delivered as active treatments for RLS and/or PLMD.

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Relationship of Periodic Movements in Sleep (Nocturnal Myoclonus) and the Babinski Sign

Cited by 71 publications

References 9 publications

Transverse Myelitis Associated with Restless Legs Syndrome and Periodic Movements of Sleep Responsive to an Oral Dopaminergic Agent But Not to Intrathecal Baclofen

Transverse Myelitis Associated with Restless Legs Syndrome and Periodic Movements of Sleep Responsive to an Oral Dopaminergic Agent But Not to Intrathecal Baclofen

Botulinum-A toxin in the treatment of painful post-stroke nocturnal paroxysmal dystonia triggered by periodic limb movements of sleep: case report

Behavioral Sleep Medicine Interventions for Restless Legs Syndrome and Periodic Limb Movement Disorder

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