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Cyclic Alternating Pattern as a Provocative Factor in Nocturnal Paroxysmal Dystonia

  1. Mario Giovanni Terzano1,*,
  2. Marie-France Monge-Straws2,
  3. Francois Mikol2,
  4. Maria Cristina Spaggiari1,
  5. Liborio Parrino1

Article first published online: 3 AUG 2005

DOI: 10.1111/j.1528-1157.1997.tb01485.x

Issue

Epilepsia

Epilepsia

Volume 38, Issue 9, pages 1015–1025, September 1997

Additional Information

How to Cite

Terzano, M. G., Monge-Straws, M.-F., Mikol, F., Spaggiari, M. C. and Parrino, L. (1997), Cyclic Alternating Pattern as a Provocative Factor in Nocturnal Paroxysmal Dystonia. Epilepsia, 38: 1015–1025. doi: 10.1111/j.1528-1157.1997.tb01485.x

Author Information

  1. 1

    Sleep Disorders Center, Department of Neurology, University of Parma, Pama, Italy

  2. 2

    Department of Neurology, Rothschild Foundation, Paris, France

*Address correspondence and reprint requests to Professor M. G. Terzano at Istituto di Neurologia, Università degli Studi, Via del Quartiere 4, 43100 Parma, Italy.

Publication History

  1. Issue published online: 3 AUG 2005
  2. Article first published online: 3 AUG 2005

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Keywords:

  • Sleep;
  • Epilepsy;
  • Cyclic alternating pattern;
  • Arousals;
  • Nocturnal paroxysmal dystonia

Summary: Purpose: We made a polygraphic study of 6 patients with nocturnal paroxysmal dystonia (NPD) in which the cyclic alternating pattern (CAP) parameters were compared with those of a group of age- and sex-matched controls.

Methods: All patients met the requirements for NPD diagnosis, characterized by generalized stereotyped movements (dystonic-dyskinetic), with a 1-min centered duration but with no clear evidence of epileptic abnormalities in the waking EEG and during nocturnal recordings.

Results: Besides the major events, the NPD polysomnograms also showed shorter, repeated episodes of shorter duration (generally <20 s) consisting of abrupt movements involving one or more body segments. Overall, the motor events in patients with NPD were closely related to periods of unstable non-REM (NREM) sleep, as evidenced by the sequences of CAP, and began during an A phase. According to the conventional scoring parameters, NPD and controls differed only in sleep latency (+14 min in the NPD patients: p < 0.04). However, the architecture of sleep in the group with NPD was characterized by prolonged and irregular NREMREM cycles. In addition, the NPD recordings showed significantly higher values of CAP rate (p < 0.0001). When major motor attacks were suppressed by medication, sleep was characterized by a decrease in the excessive amounts of CAP rate and by a more regular architecture.

Conclusions: The modulatory role of CAP on nocturnal motor events is reported.

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