Atypical head banging developed in teens persisting into adulthood as sleep-related rhythmic movement disorder.

Head banging is one subtype of sleep-related rhythmic movement disorder, characterized by stereotyped, repetitive rhythmic movements, such as lifting the head or entire upper body, banging the frontal area hard on the pillow, or slamming the occiput against a headboard. An atypical form of head banging with punching or slapping the head with a hand is extremely rare, with only 4 such cases reported so far. Herein, we present a young adult male who, since his early teens, has had atypical head banging, also called head-slapping, and discuss the neuropsychological and polysomnographic findings and review the literature. CITATION: Ji K-H, Kang M-R, Kim SJ. Atypical head banging developed in teens persisting into adulthood as sleep-related rhythmic movement disorder. J Clin Sleep Med. 2023;19(5):999-1001.

Correlations with REM sleep behavior disorder severity in isolated rapid eye movement sleep behavior disorders patients.

OBJECTIVES: The pathogenesis of isolated rapid eye movement sleep behavior disorders (iRBD) is poorly understood. The severity of RBD may reflect its pathogenesis. METHODS: We compared motor function and non-motor symptoms (NMSs) between iRBD patients and healthy volunteers. We correlated motor function, NMSs, and striatal dopaminergic activity with RBD severity using video-polysomnography. RESULTS: Twenty-one iRBD patients and 17 controls participated. The Unified Parkinson's Disease Rating Scale part III scores were higher in patients compared to controls (p < 0.001). There was no difference in upper extremity function between patients and controls (right, p = 0.220; left, p = 0.209), but gait was slower in iRBD patients (walking time, p < 0.001; number of steps, p < 0.001). The mean value of the Korean version of the Mini-Mental State Exam and Clinical Dementia Rating were lower in patients (p = 0.006, p = 0.003, respectively). Patients with were also more depressed (p = 0.002), had decreased olfactory function (p < 0.001), reported more frequent sleep/fatigue episodes (p < 0.001), worse attention/memory capacity (p < 0.001), gastrointestinal problems (p = 0.009), urinary problems (p = 0.007), and pain (p = 0.083). Further, iRBD patients reported more frequent sleep-related disturbances (p = 0.004), but no difference in daytime sleepiness (p = 0.663). Disease severity was correlated with pain (r = 0.686, p = 0.002) and visuospatial function (r= -0.507, p = 0.038). There were no correlations between RBD severity and striatal dopaminergic activities (p > 0.09). CONCLUSIONS: iRBD is a multisystem neurodegenerative disorder, and gait abnormalities may be a disease characteristic, possibly related to the akinetic-rigid phenotype of Parkinson's disease. The correlation between pain/visuospatial dysfunction and RBD severity may be related to its pathogenesis.

[Post-meningitis Dumping Syndrome: A Case Report and Literature Review].

Dumping syndrome has long been associated with gastric surgery. The authors experienced an adult patient presenting with dumping syndrome after meningitis without any previous surgical procedures on the stomach and small bowel. Dysfunction of the autonomic nervous system after infective meningitis may originate from postinfectious sequelae or an immunologic mechanism. A comprehensive study and proper management of autonomic symptoms of patients with a central nervous system infection are needed.

The first case of Anti-N-methyl-d-aspartate receptor encephalitis (Anti-NMDAR encephalitis) associated with ovarian mucinous cystadenoma: A case report.

OBJECTIVE: Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune and paraneoplastic encephalitis caused by the N-methyl-d-aspartate receptor antibody which is related to tumors, such as teratomas of the ovaries. To our knowledge, this is the first reported case of Anti-NMDAR encephalitis associated with ovarian mucinous cystadenoma. CASE REPORT: A 23-year-old woman with a flu-like illness, confused mental status, and behavioral changes presented to the hospital. A right-sided ovarian tumor was detected during the work-up and was suspected to be a teratoma that might have caused the encephalitis. A laparoscopic right salpingo-oophorectomy (RSO) was performed. Histopathological examination revealed a mucinous cystadenoma. She recovered gradually and had complete resolution of symptoms after surgical removal of the mucinous cystadenoma and immunotherapy. CONCLUSION: Even though anti-NMDAR encephalitis is caused by ovarian teratoma because it contains various types of tissues, ovarian tumors in anti-NMDAR encephalitis may not be limited to ovarian teratomas.

Predictive value of neurophysiologic monitoring during neurovascular intervention for postoperative new neurologic deficits.

PURPOSE: Forms of intraoperative neurophysiologic monitoring (IONM), including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), have been widely used in the field of neurosurgery. This study aimed to evaluate the diagnostic efficacy of IONM in identifying intraoperative events and predicting postoperative neurologic deficits in neurovascular intervention. METHODS: From January 2013 to December 2016, we retrospectively reviewed patients who underwent neurovascular intervention under general anesthesia with the use of IONM. Associations between significant changes in MEPs or SSEPs which were defined as a decrease more than 50% in amplitude and/or an increase more than 10% in latency and any identifiable intraoperative events and/or postoperative neurologic deficits were determined. The sensitivity and specificity values for both MEPs and SSEPs were calculated. RESULTS: In total, 578 patients (175 men and 403 women) were included. Their mean age was 59.5 years. SSEP changes occurred in 1% (n = 6), and MEP changes occurred in 1.2% (n = 7). Four patients suffered postoperative neurologic deficits, and identifiable intraoperative events were observed in seven patients. Both SSEP and MEP changes were significantly associated with identifiable intraoperative events and/or postoperative neurologic deficits (p < 0.001, Fisher's exact test). The calculated sensitivity and specificity of MEP monitoring were 50 and 99.5%, respectively. The sensitivity and specificity of SSEP monitoring were both 100%. CONCLUSION: Intraoperative SSEP monitoring might be a reliable and sensitive method to surveil neurologic complications during neurovascular intervention. Intraoperative MEP monitoring appears to be feasible. However, it is unclear whether MEP monitoring has any additive benefit over SSEP monitoring.

Sleep and libido in men with obstructive sleep apnea syndrome.

OBJECTIVES: The objectives of this study were to investigate the relationship between a low libido and objective sleep parameters as well as mood disturbances in patients with obstructive sleep apnea syndrome (OSA). METHODS: We enrolled 436 untreated patients who were newly diagnosed with OSA (all male, mean age 42.8 years). Patients completed the Symptom checklist-90-Revised (SCL-90-R), Epworth Sleepiness Scale (ESS), Beck Depression Inventory-II (BDI), and Beck Anxiety Inventory (BAI). Patients were divided into low-libido and normal-libido groups according to their response to the statement "Loss of sexual interest or pleasure" on the SCL-90-R. RESULTS: Approximately 23% of patients reported a low libido. Patients with a low libido were older (47.5 ± 9.0 vs. 41.4 ± 11.1 years; p < 0.001), had more nocturia (33.3% vs. 16.6%; p < 0.001), higher BDI (9.0 (5.0-14.0) vs. 5.0 (2.0-9.0); p < 0.001) and BAI score (11.0 (6.3-16.8) vs. 5.0 (2.0-10.0); p < 0.001). These patients had a lower non-REM sleep stage 3 (N3) % (0.1 (0-4.0) vs. 2.3 (0.1-7.9); p < 0.001). Multivariate analysis revealed that older age and higher BDI score were independent factors associated with a low libido. CONCLUSIONS: Men with untreated OSA suffered from a low libido. Older age and depressed mood were the most important factors of low libido in middle-aged men with OSA.

Effect of continuous positive airway pressure on regional cerebral blood flow in patients with severe obstructive sleep apnea syndrome.

OBJECTIVES: Obstructive sleep apnea (OSA) is commonly associated with neural and cognitive deficits induced by recurrent hypoxemia and sleep fragment. The aims of this study were to use statistical parametric mapping (SPM) to analyze changes in regional cerebral blood flow (rCBF) in untreated patients with severe OSA before and after nasal continuous positive airway pressure (CPAP) treatment, examine the impact of OSA-related variables on rCBF, and assess the therapeutic effect of nasal CPAP treatment. METHODS: Thirty male patients with severe OSA underwent brain single photon emission computed tomography (SPECT) scans twice before and after nasal CPAP treatment for ≥6 months, whereas 26 healthy controls underwent a single SPECT scan. The rCBF differences were compared between two OSA sub-groups (untreated and treated) and the control group, and correlations between rCBF differences and clinical parameters were analyzed. RESULTS: Compared with the controls, the untreated OSA patients showed a significantly lower rCBF in multiple brain areas. After the treatment, partial reversal of the rCBF decreases was observed in the limbic and prefrontal areas. Moreover, complete reversal of the rCBF decreases was observed in the medial orbitofrontal, angular and cerebellar areas. Significant improvements in some clinical and polysomnographic variables (Epworth Sleepiness Scale, apnea-hypopnea index, CPAP duration, and arousal index) paralleled the rCBF changes after the treatment. CONCLUSIONS: Decreased rCBF in severe OSA was significantly reversible by CPAP treatment and correlated with the improvements in the apnea-hypopnea index, arousal index, CPAP duration and Epworth Sleepiness Scale. These results suggest that long-term CPAP treatment improves rCBF in areas responsible for executive, affective, and memory function.

Early discrimination of sensorimotor Guillain-Barré syndrome into demyelinating or axonal subtype by automated nerve excitability testing.

In the early stage of disease, differentiating acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor sensory axonal neuropathy (AMSAN) using only a conventional nerve conduction studies (NCS) may be difficult. We evaluated the differences in the motor axonal excitability properties of 16 cases of sensorimotor Guillain-Barré syndrome by nerve excitability testing (NET). The antiganglioside antibody assay and follow-up NCS resulted in 12 patients diagnosed as AIDP and 4 patients as AMSAN. Clinical and excitability parameters in each group were compared with those in 30 normal controls. Automated NET with threshold tracking techniques was used to calculate the strength-duration time constant (SDTC), threshold electrotonus (TE), current-threshold relationship (CTR), and recovery cycle (RC) of excitability. Except for subtle changes in excitability parameters, AIDP showed no definitive difference relative to normal controls. Comparison between AMSAN and normal controls also revealed no significant differences in the SDTC, TE, and CTR parameters. However, there were clear differences in some of the RC parameters: the relative refractory period was significantly longer in the AMSAN group than in the AIDP group (4.40 ± 1.11 vs. 3.09 ± 1.01 ms, mean ± SEM; p < 0.001), while superexcitability was significantly less prominent in the AMSAN group (-6.80 ± 10.30 vs. -26.48 ± 1.17%, mean ± SEM; p < 0.001). Our study identified that both AIDP and AMSAN were associated with subtle changes in excitability properties. Nonetheless, the prominent increase in refractoriness in AMSAN suggests the presence of a nodal conduction block.

Relative sparing of the second lumbrical muscle in carpal tunnel syndrome is not associated with regional differences in axonal membrane potential.

OBJECTIVE: Regional differences in nerve resting membrane potential have been associated with susceptibility to entrapment neuropathy. The aim of this study was to test whether the different susceptibilities to carpal tunnel syndrome (CTS) of median nerve motor axons supplying the second lumbrical (L2) and abductor pollicis brevis (APB) muscles could be explained in this way. METHODS: Computerized nerve-excitability testing was used to examine the excitability properties of the median motor axons of both L2 and APB in 24 healthy volunteers. RESULTS: Although some excitability measurements differed between the L2 and APB motor axons, estimates of resting membrane potential (RMP) by model fitting indicated no significant difference between the two groups. CONCLUSION: Differences in RMP cannot account for the relative sparing of L2 axons in severe CTS. SIGNIFICANCE: L2 sparing in CTS most likely has an anatomical rather than a biophysical basis.