Sleep talking and primary progressive aphasia: case study and autopsy findings in a patient with logopenic primary progressive aphasia and dementia with Lewy bodies.

This case study highlights the parasomnia behaviours of an individual with primary progressive aphasia, a type of dementia known for decline in language abilities. Despite a paucity of speech during the day, this individual had concurrent sleep talking at night; a combination which, to our knowledge, has never been reported before. Post-mortem pathology confirmed clinical suspicion of both Alzheimer and Lewy body diseases, both asymmetric to the left side. Given this rare left-sided asymmetrical pathology, we hypothesise that the relatively preserved right hemisphere may have allowed for access to intact overlearned phrases which usually originate from the right hemisphere to appear while asleep. A second hypothesis is also presented which postulates that bottom-up processing may have overridden top-down apathy during sleep and allowed for speech output in this case.

Association Between Alcohol Consumption and Nocturnal Leg Cramps in Patients Over 60 Years Old: A Case-Control Study.

PURPOSE: Nocturnal leg cramps are a specific kind of cramps affecting almost one-half of patients aged 60 years and older. They reduce patients' quality of sleep and have a negative impact on their quality of life. The aim of this study was to evaluate the association between nocturnal leg cramps and the consumption of alcoholic beverages in patients aged 60 years and older attending general practices. METHODS: Case-control study with a Bayesian approach for sensitivity analysis. Participants were voluntary ambulatory patients aged 60 years and older consulting their family doctor. They were recruited in 67 general practices across the Alsace region. Cases (patients having cramps), were matched with controls (patients free from cramps) for age, sex, medical history, and medications known to trigger cramps. Alcohol consumption was assessed through a standardized food frequency questionnaire. RESULTS: We found an association between the global consumption of alcoholic beverages and nocturnal leg cramps (OR = 6.5, 95% credibility interval, 1.68-38.05; posterior probability 99.82%). CONCLUSION: We identified an association between alcohol consumption and nocturnal leg cramps among patients aged 60 years and older attending general practices. These findings have implications for the prevention of cramps.

Nocturnal leg symptoms are not associated with specific patterns of superficial venous insufficiency.

BACKGROUND: Certain nocturnal symptoms such as leg cramping (LC) and restless leg symptoms (RLS) are found in patients with venous disease. This study investigates the relationship between nocturnal symptoms and anatomic locations of superficial venous insufficiency. METHODS: A retrospective review of 371 consecutive patients presenting to a venous disease practice over a 1-year period was conducted. Patients underwent comprehensive assessment including standardized duplex scans. Superficial venous disease was classified by anatomic location (great saphenous vein [GSV], small saphenous vein [SSV], tributaries). Information on patient symptoms was obtained from questionnaires and patient interviews. RESULTS: Most patients in the cohort were female (315/371, 85%) with an average age of approximately 56 years. The 56 men had an average age of 63.2. Nearly all patients (92%) had findings of superficial venous reflux with the anatomic site of involvement as follows: GSV (51%), SSV (16%), and tributaries (33%). Thirty-two percent of patients experienced LC and 16% experienced RLS. The patterns of reflux did not differ between patients with nocturnal symptoms compared to those without nocturnal symptoms. Nine percent of patients with nocturnal symptoms had no evidence of venous disease. Of those patients with LC, 76% had reflux in the GSV, 48% had reflux in the SSV, and 92% had reflux in at least one segment of the superficial venous system. Of those patients with RLS, 78% had reflux in the GSV, 35% had reflux in the SSV, and 87% had reflux in at least one segment of the superficial venous system. CONCLUSIONS: No significant difference was detected between patterns of superficial venous reflux in patients with nocturnal symptoms compared to those without nocturnal symptoms. In addition, the presence of nocturnal symptoms does not predict a specific pattern of disease. Future studies are needed to determine whether correction of the main truncal disease is sufficient or if ablation of both the truncal and tributary veins is necessary for alleviation of nocturnal symptoms.

Criteria in diagnosing nocturnal leg cramps: a systematic review.

BACKGROUND: Up to 33% of the general population over 50 years of age are affected by nocturnal leg cramps. Currently there are no generally accepted clinical characteristics, which identify nocturnal leg cramps. This study aims to identify these clinical characteristics and to differentiate between them and the characteristics of restless leg syndrome and periodic limb disorder. METHOD: A systematic literature study was executed from December 2015 to May 2016. This study comprised of a systematic literature review of randomized clinical trials, observational studies on nocturnal and rest cramps of legs and other muscles, and other systematic and narrative reviews. Two researchers independently extracted literature data and analyzed this using a standardized reviewing protocol. Modified versions of the Cochrane Collaboration tools assessed the risk of bias. A Delphi study was conducted to assess agreement on the characteristics of nocturnal leg cramps. RESULTS: After systematic and manual searches, eight randomized trials and ten observational studies were included. On the basis of these we identified seven diagnostic characteristics of nocturnal leg cramps: intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption and distress. CONCLUSION: The seven above characteristics will enhance recognition of the condition, and help clinicians make a clear distinction between NLC and other sleep-related musculoskeletal disorder among older adults.

Botulinum Toxin Treatment for Nocturnal Calf Cramps in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial.

OBJECTIVES: To evaluate the clinical effectiveness of botulinum toxin (BTX) injection into the gastrocnemius muscles in patients with lumbar spinal stenosis (LSS) who have frequent nocturnal calf cramps (NCCs). DESIGN: Prospective, randomized clinical trial. SETTING: Outpatient department for interventional pain management. PARTICIPANTS: Patients (N=50) with LSS who have NCCs at least once per week were enrolled. INTERVENTION: Patients were randomly allocated to receive either conservative treatments plus gabapentin (group GPN) or BTX injection (group BTX). MAIN OUTCOME MEASURES: We assessed back/leg pain intensity, the frequency and severity of NCCs, insomnia severity, and functional disability at baseline and after 2 weeks, 1 month, and 3 months. Additionally, Patient Global Impression of Change was assessed. RESULTS: Forty-five patients completed all assessments (group GPN, n=21; group BTX, n=24). Compared with group GPN, leg pain intensity, cramp frequency, and cramp severity were significantly decreased in group BTX at all follow-up visits (all, P<.01). Also, insomnia significantly improved in group BTX at the 2-week (P=.018) and 1-month follow-up (P=.037). Functional disability significantly improved in group BTX at 2 weeks' follow-up (P=.041). At the 3-month follow-up, patients in group BTX reported a higher impression of improvement for NCC symptoms than did those in group GPN (P<.001). A mean dose of 642.8mg of gabapentin was given daily in group GPN, but 7 patients (33.3%) reported systemic side effects. There were no serious complications related to BTX use. CONCLUSIONS: BTX treatment appears to be effective and safe for NCCs in symptomatic LSS patients receiving conservative care.

Treatment of nocturnal leg cramps by blockade of the medial branch of the deep peroneal nerve after lumbar spine surgery.

INTRODUCTION: Patients with lumbar spine disease sometimes complain of nocturnal leg cramps. We sought to investigate the effectiveness of blocking the medial branch of the deep peroneal nerve as treatment for nocturnal leg cramps after spinal surgery for lumbar spine disease. METHODS: We evaluated 66 postoperative patients in this prospective comparative study of a group of patients with a nerve block (n = 41) and a control group without (n = 25). In the block group, the medial branch of the deep peroneal nerve was blocked at the distal two-thirds of the interspace between the first and second metatarsals using 5.0 mL of 1.0% lidocaine. RESULTS: Two weeks after the block, the frequency of nocturnal leg cramps was reduced to less than a quarter of pretreatment baseline frequency in 61.0% of patients (n = 25) and less than half in 80.5% (n = 33). In the control group, the frequency of the leg cramps was reduced from baseline in 32.0% of patients (n = 8), and was unchanged or increased in 68.0% (n = 17) at 2 weeks. Cramp frequency was reduced to less than a quarter or less than half of baseline frequency in a significantly (P < 0.05 and P < 0.01, respectively) larger percentage of patients in the block group. The severity of each cramp was less in about two-thirds of patients (63.4%; n = 26) in the block group and was unchanged in one-third (31.7%; n = 13). CONCLUSIONS: Blocking the medial branch of the peroneal nerve can be an effective, long-lasting, and simple treatment with low risk for nocturnal cramps sustained after lumbar spine surgery.

Sexsomnia: sleep sex research and its legal implications.

"Sleep sex," also known as sexsomnia, is a sleep disorder characterized by sexual behaviors committed while asleep. There has recently been increased interest in sexsomnia due to controversies arising in legal trials that have been widely publicized in the social and public media. This article attempts to marshal the current information about sexsomnia from the forensic literature and provides an overview of sexsomnia including common features, precipitating factors, prevalence rates, diagnostic procedures, and treatment. As sexsomnia represents a condition in which sexual acts are committed without awareness or intention, this paper also reviews the development of sexsomnia as a legal defense and summarizes Canadian case law on the topic. It provides an overview of the hurdles presented to defense attorneys attempting to utilize the defense and examines popular public notions surrounding the legitimacy of sexsomnia and the possibility of malingering. We conclude that sexsomnia is a legitimate sleep disorder for which case law now exists to support its use in legal defenses based on automatism. The question of whether it is an example of "sane" or "insane" automatism remains to be determined by the courts. Regardless of whether or not sexsomnia is determined to be a mental disorder by the courts, it is now a recognized and well-described sleep disorder that can be safely treated and managed by knowledgeable clinicians.

Parasomnias and isolated sleep symptoms in Parkinson's disease: a questionnaire study on 661 patients.

BACKGROUND: Sleep disorders are among the most common non-motor symptoms in Parkinson's disease. METHOD: The prevalence of parasomnias and their association with other symptoms were studied in a questionnaire study among 1447 randomly selected Parkinson patients, aged 43 to 89 years. The response rate was 59.0% and of these 77% had answered to all questions that were used in the analyses (N = 661). RESULTS: The prevalence of REM sleep behavior disorder (RBD) evaluated by the RBDSQ ≥ 6 was 39.0%. The occurrences of other parasomnias (≥ 1/week) in patients with PD were: nightmares 17.2%, night terrors 3.9%, sleepwalking 1.8%, enuresis 21.0%, and hallucinations 15.3%. Occurrences (≥ 1/week) of the isolated sleep symptoms were: nocturnal sweating 28.8%, bruxism 4.7%, and sleep talking 21.7%. Association of RBD with sleepwalking (parasomnia overlap disorder) was found in 1.7% of all PD patients. Adjusted logistic regression analysis showed that weekly nightmares (OR 12.5; 95% CI 5.3 to 29.7), hallucinations (OR 5.1; 2.1 to 12.4), sleep talking (OR 11.6; 5.9 to 22.8), male gender (OR 1.9; 1.1 to 3.1), and restless legs syndrome (OR 4.7; 1.7 to 13.2) associated with the presence of RBD. CONCLUSION: Parkinson patients with RBD have often also other parasomnias and/or isolated sleep symptoms.

Delayed thalamic astrocytosis and disrupted sleep-wake patterns in a preclinical model of traumatic brain injury.

Traumatic brain injury (TBI) involves diffuse axonal injury and induces subtle but persistent changes in brain tissue and function and poses challenges for early detection of neurological injury. The present study uses an automated behavioral analysis system to assess alterations in rodent behavior in the subacute phase in a preclinical mouse model of TBI, controlled cortical impact (CCI) injury. In the first few weeks following CCI, mice demonstrated normal exploratory behaviors and other typical home-cage behaviors. However, beginning 4 weeks post-injury, CCI mice developed disruptions in sleep-wake patterns, including an increased number of awakenings from sleep. Such impaired sleep maintenance was accompanied by an increased latency to reach peak sleep in CCI mice. These sleep disruptions implicate involvement of the thalamocortical network, the activity of which must be tightly regulated to control sleep maintenance. After injury, there was an increase in reactive microglia in thalamic regions as well as delayed reactive astrocytosis that was evident in the thalamic reticular nucleus, which preceded the development of sleep disruptions. These data suggest that cortical injury may trigger inflammatory responses in deeper neuroanatomical structures, including the thalamic reticular nucleus. Such engagement of the thalamus may perturb the thalamocortical network that regulates sleep/awake patterns and contribute to sleep disruptions observed in this model as well as those documented in patients with TBI.

CPAP treats muscle cramps in patients with obstructive sleep apnea.

We describe a case series of 4 patients with varying degrees of obstructive sleep apnea who incidentally had a history of nocturnal leg cramps. None of the patients had periodic limb movements during the study and denied symptoms consistent with restless legs syndrome. In 3 of the 4 patients, nocturnal leg cramps resolved with CPAP treatment for OSA, while the fourth patient noted near-resolution of cramping after starting CPAP. In patients presenting with muscle cramps, obstructive sleep apnea should be considered.

Exploding head syndrome.

Exploding head syndrome is characterized by the perception of abrupt, loud noises when going to sleep or waking up. They are usually painless, but associated with fear and distress. In spite of the fact that its characteristic symptomatology was first described approximately 150 y ago, exploding head syndrome has received relatively little empirical and clinical attention. Therefore, a comprehensive review of the scientific literature using Medline, PsycINFO, Google Scholar, and PubMed was undertaken. After first discussing the history, prevalence, and associated features, the available polysomnography data and five main etiological theories for exploding head syndrome are summarized. None of these theories has yet reached dominance in the field. Next, the various methods used to assess and treat exploding head syndrome are discussed, as well as the limited outcome data. Finally, recommendations for future measure construction, treatment options, and differential diagnosis are provided.

Nocturnal leg cramps.

Up to 60 percent of adults report that they have had nocturnal leg cramps. The recurrent, painful tightening usually occurs in the calf muscles and can cause severe insomnia. The exact mechanism is unknown, but the cramps are probably caused by muscle fatigue and nerve dysfunction rather than electrolyte or other abnormalities. Nocturnal leg cramps are associated with vascular disease, lumbar canal stenosis, cirrhosis, hemodialysis, pregnancy, and other medical conditions. Medications that are strongly associated with leg cramps include intravenous iron sucrose, conjugated estrogens, raloxifene, naproxen, and teriparatide. A history and physical examination are usually sufficient to differentiate nocturnal leg cramps from other conditions, such as restless legs syndrome, claudication, myositis, and peripheral neuropathy. Laboratory evaluation and specialized testing usually are unnecessary to confirm the diagnosis. Limited evidence supports treating nocturnal leg cramps with exercise and stretching, or with medications such as magnesium, calcium channel blockers, carisoprodol, or vitamin B(12). Quinine is no longer recommended to treat leg cramps.

Relationship between prolonged standing and symptoms of varicose veins and nocturnal leg cramps among women and men.

The relationships between occupational characteristics and symptoms of varicose veins and nocturnal leg cramps and their gender differences were explored in a Korean population. The study population was 2165 workers from various occupations (55.6% female). Multiple logistic regression analyses were conducted to reveal factors related to symptoms of varicose veins and nocturnal leg cramps. The prevalence of varicose veins and nocturnal leg cramps was higher among women than men. The characteristics of standing work were different according to gender. In gender stratified analysis, the odds ratio of varicose veins was significantly high for prolonged standing for male and female workers. However, the odds ratio of nocturnal leg cramps was only significant among prolonged standing male workers. The models including gender, prolonged standing and occupations in this order presented that gender is not significantly associated with varicose veins after occupations were added to the model. Prolonged standing at work may be a more important risk factor for varicose veins and nocturnal leg cramps than biological differences between women and men. Therefore, effective interventions to interrupt or reduce prolonged standing at work should be implemented for the prevention of varicose veins and nocturnal leg cramps. PRACTITIONER SUMMARY: This paper shows associations between occupational characteristics and symptoms of varicose veins and nocturnal leg cramps and their gender differences. These findings will contribute to knowledge of gender-specific occupational risk factors for symptoms in the distal lower extremities.

Sleep-to-wake transition movement disorders.

Consciousness and vigilance level are important factors for the manifestation and variability of many disorders, including movement disorders. Usually lumped together into unspecified "Wakefulness," the transition between wakefulness and sleep--the pre-dormitum, and between sleep and wakefulness--the post-dormitum, possess intrinsic cerebral metabolic patterns and mental, behavioural, and neurophysiological characteristics which make these peculiar states of vigilance independent. Moreover, the pre- and post-dormitum, with the relative state-dependent changes in firing patterns of many neuronal supra-pinal populations, act to release pacemakers responsible for different sleep-related motor phenomena. The relevance of pre-dormitum and post-dormitum as states different from full wakefulness and full sleep is, indeed, indicated by disorders which appear exclusively during either state, including motor disorders such as propriospinal myoclonus and awakening epilepsy. We will focus on three paradigmatic physiological/pathological motor phenomena (rhythmic movement disorder, hypnic jerks, and propriospinal myoclonus) strictly linked to the sleep-wake transition periods. Thereafter we will briefly discuss how the process of pre-dormitum and post-dormitum can lead to such disruption of motor control.