The neurophysiology of the alternating leg muscle activation (ALMA) during sleep: Study of one patient before and after treatment with pramipexole
The neurophysiology of the alternating leg muscle activation (ALMA) during sleep: Study of one patient before and after treatment with pramipexole
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DOI：
10.1016/j.sleep.2005.06.007
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发表时间：
2006-01-01
期刊：
影响因子：
4.8
通讯作者：
Ferri, R
中科院分区：
文献类型：
--
作者：
Cosentino, FII;Iero, I;Ferri, R
背景和目的：报告睡眠期间腿部肌肉交替激活 (ALMA) 患者的神经生理学特征，这是一种胫骨前肌激活的快速交替模式，可能代表脊髓中枢模式发生器对运动的短暂促进，可能是由于抗抑郁药物的血清素作用所致。患者和方法：一名 33 岁的 ALMA 男性患者。对患者在睡眠期间、普拉克索治疗前后的神经生理学参数进行了完整而详细的研究。结果：普拉克索治疗后，ALMA 的发生率、报告的失眠和白天嗜睡的发生率显着降低。在大多数情况下，ALMA 之前通常会出现循环交替模式 A 阶段和心率增加。视觉评分和光谱分析表明，普拉克索后需要更强烈的唤醒才能触发 ALMA。结论：普拉克索治疗引起的明显有益效果表明，参与 ALMA 生成的脊髓网络也可能受到多巴胺能网络的抑制控制。我们认为，即使在没有抗抑郁治疗、睡眠呼吸暂停或睡眠期间周期性腿部运动等其他因素的情况下，也可以看到 ALMA，并且可能被视为受睡眠不稳定影响的附加现象。我们的患者似乎还表明，多巴胺激动剂治疗对此类患者可能有用，因为治疗后可以获得良好的临床反应。 (c) 2005 Elsevier B.V. 保留所有权利。
Background and purposes: To report the neurophysiological features of a patient with alternating leg muscle activation (ALMA) during sleep, a quickly alternating pattern of anterior tibialis activation which might represent transient facilitation of a spinal central pattern generator for locomotion, perhaps due to the serotonergic effects of antidepressant medication.Patient and methods: A 33-year-old male patient with ALMA. The patient underwent a complete and detailed study of his neurophysiological parameters during sleep, before and after treatment with pramipexole.Results: The treatment with pramipexole was followed by a significant reduction in the rate of occurrence of ALMA, in reported insomnia, and in daytime sleepiness. The ALMA generally were preceded by cyclic alternating pattern A phases and increased heart rate in most instances. Visual scoring and spectral analyses suggested that after pramipexole more intense arousal was required to trigger ALMA.Conclusion: The evident beneficial effect induced by the treatment with pramipexole indicates that the spinal networks involved in the generation of ALMA might also be under the inhibitory control of dopaminergic networks. We suggest that ALMA can be seen even in the absence of other factors such as antidepressant therapy, sleep apnea or periodic leg movements during sleep, and might be considered as an additional phenomenon influenced by sleep instability. Our patient seems to indicate also that treatment with dopamine agonists can be useful in such patients because the treatment can be followed by a good clinical response. (c) 2005 Elsevier B.V. All rights reserved.