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Sleep and Movement Disorders
Elio Lugaresi M.D.and Federica Provini M.D.
This review focuses on some movement disorders classified according to time of occur-
rence:i)on falling asleep (restless legs syndrome,nocturnal myoclonus and propriospinal
myoclonus;ii)during NREM sleep (nocturnal frontal lobe epilepsy);iii)during REM sleep
(REM sleep behaviour disorders).Restless legs syndrome (RLS)is characterized by deep
ill-defined paresthesias in the legs arising during postural rest,especially when the patient
is trying to fall asleep.Motor agitation of the legs is associated with periodic involuntary
movements,named nocturnal myoclonus (NM)or periodic limb movements in sleep
(PLMS).NM may appear independently of RLS and can induce sleep fragmentation,but
not necessarily an insomniac complaint.Propriospinal myoclonus (PSM)is characterized
by jerks arising from an axial muscle and spreading up and down via multisynaptic path-
ways,for several segments and appears when patients are relaxed trying to fall asleep,giv-
ing rise to severe insomnia.Nocturnal frontal lobe epilepsy is characterized by a spectrum
of stereotyped dystonic-dyskinetic motor attacks of different intensity and duration and
occurring during slow wave sleep.Diagnosis must be made by audiovisual recording as
polygraphic recordings rarely show ictal and interictal epileptic abnormalities.REM sleep
behaviour disorders (RBD)are episodes of motor agitation arising during REM sleep due
to the absence of muscular atonia and are characterized by more or less purposeful ges-
tures enacting attack or defence reactions,sometimes associated with emotional expres-
sions of joy,laughter or sorrow.RBD often herald other signs and symptoms of neurode-
generative disorders like Parkinsonian syndromes.If correctly diagnosed,all these sleep
movement disorders can be treated successfully.(Sleep and Hypnosis 2001;3(2):55-61)
| Keywords: movement disorders, restless legs syndrome, nocturnal myoclonus, pro-priospinal myoclonus, nocturnal frontal lobe epilepsy, REM sleep behaviour disorders |
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