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Nocturnal Myoclonus

Sleep Myoclonus


Presentation

  • On the other hand, symptomatic nocturnal myoclonus is typically associated with restless legs syndrome; in this condition, it is usually severe and present also during wakefulness. The exact site of origin of nocturnal myoclonus is unknown.[ncbi.nlm.nih.gov]
  • Presently, the accepted hypothesis is that many PNSs are caused by immune mechanisms triggered against antigens that are normally present in the nervous system and ectopically expressed by the tumor (onconeural antigens).[bloodjournal.org]
  • Myoclonic disorders are often disabling and difficult to treat and present a therapeutic challenge to the physician.[jamanetwork.com]
  • Southport Records and The Southport Composers Series sees the need for living composers to not only produce and notate their compositions, but to present them to the world via Compact Disc. Media, we appreciate your time and support![amazon.com]
  • A family history of epilepsy is usually present in ADNFLE. Autosomal dominant inheritance means an abnormal gene from one parent can cause disease in a child.[epilepsy.com]
Pain
  • Other abnormal movements that may be confused with nocturnal myoclonus are the startles of hyperekplexia, the syndrome of painful legs and moving toes, nocturnal leg cramps, and the numerous varieties of epileptic myoclonus.[ncbi.nlm.nih.gov]
  • RLS may be accompanied by involuntary limb movements while the patient is asleep Management For nightly symptoms, dopaminergics are the agents of first choice, opiates second choice; for pain, gabapentin, opiates, dopaminergics, then sedative-hypnotics[medical-dictionary.thefreedictionary.com]
  • Clonazepam, (Klonopin), in doses from 2 to 8 mg at bedtime, has been shown to significantly reduce leg kicks in a patient who had nocturnal myoclonus to the degree that leg and knee pain persisted throughout the next day.[wikidoc.org]
  • A mood of tension and pained beauty is cast in the first segment of “Pieces of Night.” This is not a lazy nocturne, but one born of the fear of war and it’s futility.[amazon.com]
  • Vasculitic neuropathy Isolated vasculitis of peripheral nerves has been reported in a few patients with solid tumors and lymphomas. 96 The clinical course is characterized by a progressive, initially asymmetric, painful sensorimotor neuropathy.[bloodjournal.org]
Movement Disorder
  • Nocturnal myoclonus is sometimes called periodic limb movement disorder (PLMD).[medical-dictionary.thefreedictionary.com]
  • ., M.D. [1] Overview Periodic Limb Movement Disorder (PLMD), also called nocturnal myoclonus, is a sleep disorder where the patient moves limbs involuntarily during sleep and has symptoms or problems related to the movement.[wikidoc.org]
  • Movement Disorders. Wiley. 12 (1): 61–5. doi : 10.1002/mds.870120111. PMID 8990055. Ferri R., Novelli L., and Bruni O. (2013) Periodic Limb Movement Disorder. In: Kushida C. (ed.) The Encyclopedia of Sleep, vol. 4, pp. 43-47.[en.wikipedia.org]
  • PLMS still appear as a complex and multivarious movement disorder that implicates many brain areas, including regions belonging to the medial pain system (thalamus, anterior cingulate and insula) where abnormal dopamine and opioid activity has been found[practicalneurology.com]
Excessive Daytime Sleepiness
  • As many as 12.2% of patients suffering from insomnia and 3.5% of patients suffering from excessive daytime sleepiness may experience PLMS. PLMS is related to restless leg syndrome (RLS) in that 80% of people with RLS also have PLMS.[wikidoc.org]
  • Clinical investigations addressing the correlations of excessive daytime sleepiness and PLMS are, however, contradictory.[practicalneurology.com]
  • These movements can lead the patient to wake up, and if so, sleep interruption can be the origin of excessive daytime sleepiness. [2] PLMD is characterized by increased periodic limb movements during sleep (PLMS), which must coexist with a sleep disturbance[en.wikipedia.org]
Hypersomnia
  • "Periodic leg movements are not more prevalent in insomnia or hypersomnia but are specifically associated with sleep disorders involving a dopaminergic impairment". Sleep Medicine. 1 (2): 163–167. doi : 10.1016/S1389-9457(00)00014-9. PMID 10767664.[en.wikipedia.org]
  • […] and sleep complaints reported a 3.9 percent prevalence in 18,980 subjects from the general population between 15 and 100 years of age. 38 PLMS indeed occurs in various sleep disorders such as obstructive sleep apnea syndrome (OSA), 53,54 insomnia 55, hypersomnia[practicalneurology.com]
Nocturnal Leg Cramp
  • Other abnormal movements that may be confused with nocturnal myoclonus are the startles of hyperekplexia, the syndrome of painful legs and moving toes, nocturnal leg cramps, and the numerous varieties of epileptic myoclonus.[ncbi.nlm.nih.gov]
Hypertension
  • Insomnia Primary sleep disorders Sleep apnea Nocturnal myoclonus Restless legs syndrome Hypnic jerks Medical disorders Asthma Chronic obstructive pulmonary disease Coronary or pulmonary insufficiency Dementia Epilepsy Fibrositis Gastroesophageal reflux Hypertension[freethesaurus.com]
  • It is important to remember clinical investigations addressing the correlations between PLMS and increased risk for hypertension and coronary artery disease are still contradictory.[practicalneurology.com]
Heart Disease
  • disease, obstructive sleep apnea, cataplexy, doing physical activities close to bedtime and the presence of a mental disorder were significantly associated with having a higher risk of both PLMD and restless legs syndrome. [8] PLMS seem to find an origin[en.wikipedia.org]
Ulcer
  • […] myoclonus Restless legs syndrome Hypnic jerks Medical disorders Asthma Chronic obstructive pulmonary disease Coronary or pulmonary insufficiency Dementia Epilepsy Fibrositis Gastroesophageal reflux Hypertension Hyperthyroidism Parkinson's disease Peptic ulcer[freethesaurus.com]
Restless Legs Syndrome
  • Related to nocturnal myoclonus: PLMD Graphic Thesaurus Legend Synonym Antonym Related noun Synonyms for restless legs syndrome feeling of uneasiness and restlessness in the legs after going to bed (sometimes causing insomnia) References in periodicals[freethesaurus.com]
  • PLMS is related to restless leg syndrome (RLS) in that 80% of people with RLS also have PLMS. However, most people with PLMS do not experience RLS.[wikidoc.org]
  • On the other hand, symptomatic nocturnal myoclonus is typically associated with restless legs syndrome; in this condition, it is usually severe and present also during wakefulness. The exact site of origin of nocturnal myoclonus is unknown.[ncbi.nlm.nih.gov]
  • PLMD should not be confused with restless legs syndrome (RLS). RLS is characterized by a voluntary response to an urge to move legs due to discomfort.[en.wikipedia.org]
  • • Eighteen members of a family were affected over a span of five generations with the restless legs syndrome, transmitted as an autosomal dominant trait. Ten patients had myoclonus.[jamanetwork.com]
Leg Cramp
  • Other abnormal movements that may be confused with nocturnal myoclonus are the startles of hyperekplexia, the syndrome of painful legs and moving toes, nocturnal leg cramps, and the numerous varieties of epileptic myoclonus.[ncbi.nlm.nih.gov]
Knee Pain
  • Clonazepam, (Klonopin), in doses from 2 to 8 mg at bedtime, has been shown to significantly reduce leg kicks in a patient who had nocturnal myoclonus to the degree that leg and knee pain persisted throughout the next day.[wikidoc.org]
Suggestibility
  • Ancoli-Israel and Daniel F Kripke and William J Mason and Sam Messin}, journal {Sleep}, year {1981}, volume {4 4}, pages { 349-58 } } Sonia Ancoli-Israel, Daniel F Kripke, 1 author Sam Messin Published in Sleep 1981 DOI: 10.1093/sleep/4.4.349 Studies have suggested[semanticscholar.org]
  • The antigens recognized by these antibodies are not expressed in lymphoma cells, suggesting the tumor itself does not trigger the PNS.[bloodjournal.org]
  • A number of studies suggest that PLMS may be a risk factor for cardiac diseases.[practicalneurology.com]
  • Research evidence suggested iron is possibly contributing to PLMD.[en.wikipedia.org]
Compulsive Disorder
  • disorder Borderline personality disorder Post-traumatic stress syndrome Adjustment disorders Anorexia nervosa Dementia Alcohol and substance abuse Phobia Psychologic disorders Preexisting emotional problems Inadequate coping strategies Internalization[freethesaurus.com]
Insomnia
  • Related to nocturnal myoclonus: PLMD Graphic Thesaurus Legend Synonym Antonym Related noun Synonyms for restless legs syndrome feeling of uneasiness and restlessness in the legs after going to bed (sometimes causing insomnia) References in periodicals[freethesaurus.com]
  • PLMS can cause insomnia and daytime sleepiness. The incidence of this disorder increases with age.[wikidoc.org]
  • Restless legs, see there; a condition of periodic lower-leg movements during sleep with associated daytime sleepiness, or complaints of insomnia.[medical-dictionary.thefreedictionary.com]
  • "Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study". Sleep. 21 (5): 501–5. doi : 10.1093/sleep/21.5.501. PMID 9703590. Hornyak M, Trenkwalder C (May 2004).[en.wikipedia.org]
  • PLMS may even trigger RLS symptoms in the same patient, 86 representing a complication of long-term dopaminergic treatment today called "augmentation." 87 In patients who present with symptoms of sleep disturbance such as excessive daytime sleepiness, insomnia[practicalneurology.com]
Myoclonic Jerking
  • It has frequently been confused with, and should be clearly differentiated from, other normal jerking movements of sleep, such as partial myoclonic jerks and massive myoclonic jerks, or sleep starts.[ncbi.nlm.nih.gov]
  • Jerk, Myoclonic. Jerking, Myoclonic. Jerks, Myoclonic. Lower Extremity Myoclonus. Myoclonic Jerks. Nocturnal Myoclonus. Oculopalatal Myoclonus. Palatal Myoclonus. Segmental Myoclonus. Simplex, Myoclonus. Sleep Myoclonus. Upper Extremity Myoclonus.[trigramas.bireme.br]
  • Attempts to control myoclonic jerks have been made with several drugs, of which only clonazepam 1 and L-5-hydroxytryptophan (L-5-HTP) 2 seem to have long-term value in practice.[jamanetwork.com]
  • They include: a tonic activity lasting several hundreds of milliseconds possibly followed by myoclonic activity, an initial myoclonic jerk followed by tonic activity or several myoclonic jerks in clusters sometimes followed by tonic activity.[practicalneurology.com]
Involuntary Movements
  • Primary sleep disorders, such as nocturnal myoclonus (repetitive involuntary movements of the extremities during sleep) and restless leg syndrome (in which a peculiar "crawling" sensation occurs in the calves or thighs when lying down), are less frequent[freethesaurus.com]
  • movements come from lower extremities (including toes, ankles, knees, and hips), although they can also be observed in upper extremities, occasionally. [5] PLMS seem to be common features within a large number of people, and identifying whether or not[en.wikipedia.org]
Akathisia
  • A condition defined as a distressing need or urge to move the legs (or arms)—akathisia—usually accompanied by an uncomfortable deep-seated sensation in the legs that is brought on by rest—sitting or lying down, relieved by moving or walking, and worse[medical-dictionary.thefreedictionary.com]
Somnolence
  • PLMS may be responsible for difficulties in initiating and maintaining sleep and for sleep fragmentation with consequent daytime somnolence.[practicalneurology.com]

Treatment

  • Not all patients with PLMS have PLMD (in fact, most people with PLMS do not have a disorder requiring any treatment). PLMS is diagnosed with the aid of a polysomnogram or PSG.[wikidoc.org]
  • About 30% of cases are resistant to treatment. If your seizures are not controlled, seek out the help of an epilepsy specialist or visit an epilepsy center to explore all treatment options.[epilepsy.com]
  • There are also a few case reports of patients with a subacute sensory neuropathy that had complete recovery after treatment of the HL.[bloodjournal.org]
  • […] of sleep and non-sleep disturbances, 82,44 it is not possible to indicate specific treatments for this sleep-related motor phenomenon.[practicalneurology.com]
  • These medications are also successful for the treatment of restless legs syndrome. In one study, co-careldopa was superior to dextropropoxyphene in decreasing the number of leg kicks and the number of arousals per hour of sleep.[en.wikipedia.org]

Prognosis

Etiology

  • Diagnostic criteria of PNSs The presence of a neurological syndrome of unclear etiology at the time of the diagnosis of a tumor does not necessarily mean that the neurological syndrome is paraneoplastic, as this could represent the coincidental occurrence[bloodjournal.org]
  • […] the hypothalamus (hypothalamic A11 nucleus) with descending pathways that target the preganglionic sympathetic neurons—the dorsal horn region, the interneurons, and the somatic motor neurons, has been hypothesized as being intimately involved in the etiology[practicalneurology.com]

Epidemiology

  • Actigraphy offers a convenient and economical alternative to polysomnography in the study of large populations to increase our understanding of the epidemiology and clinical significance of the PLMs. 10 Physicians must note that actigraphy alone should[practicalneurology.com]
  • […] insufficient evidences related to the efficacy of pharmacological treatment in PLMD, and its use has been based on the dopaminergic medication effect on RLS. [5] Therefore, a careful clinical monitoring with any pharmacological use in PLMD is recommended. [5] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Impairment in brain iron availability 26,27 and the link between iron deficiency and reduction in central dopaminergic tone 28,29 coupled with the knowledge that central dopamine signaling exhibits a daily rhythm with a nadir in the evening, 30 support the pathophysiologic[practicalneurology.com]

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