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sleep movement disorder Flashcards

1
Q

A Limb Movement that is part of a PLMS sequence is between 0.5 and 10 seconds and it is not within 0.5 seconds of a respiratory event ?

A

true

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2
Q

Which vitamin deficiency was recently associated with an increased incidence of RLS?

A

Vitamin D

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3
Q

What are some genetic disorders associated with primary central nervous system hypersomnia

A 
Niemann-Pick type C disease
Norrie disease associated with daytime somnolence
Prader-Willi syndrome
Myotonic dystrophy
Moebius syndrome
Fragile X
Smith-Magenis
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4
Q

What are some syndromes associated with hypersomnia due to medical disorder

A

Residual hypersomnia in patient’s adequately treated for obstructive sleep apnea
Hypersomnia due to endocrine disorder (thyroid)
Hypersomnia secondary to metabolic encephalopathy
Hypersomnia secondary to brain tumors infections or other central nervous system lesions
Hypersomnia associated with genetic disorders associated with central nervous system lesions
Posttraumatic hypersomnia
Hypersomnia secondary to Parkinson’s disease

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5
Q

How are leg monitoring electrolytes set up

A

Leg monitoring electrodes are longitudinal and symmetrical in the middle of the anterior tibialis muscle 2-3 cm apart R1 third the length of the muscle

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6
Q

Where are REM sleep movement electrodes placed

A

Movement electrodes were placed on the flexor digitorum superficialis for detecting transient muscle activity and REM sleep.Alternatively may be placed on the extensor digitorum communis

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7
Q

How is diagnosis REM behavior disorder made

A

Always REM behavior disorder diagnosed. Both audio quit the video is necessar as well as polysomnographic evidence of REM sleep without atonia.

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8
Q

How is rhythmic movement disorder diagnosed

A

For monitoring rhythmic movement disorder, bipolar surface electrode should be placed to record electrical activity of the large muscle groups involved. Synchronized video recording is necessary.

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9
Q

What are rules for arousals in PLM

A

For monitoring rhythmic movement disorder, bipolar surface electrode should be placed to record electrical activity of the large muscle groups involved. Synchronized video recording is necessary.

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10
Q

How is PML associated with an arousal

A

An arousal and a limb movement that occurr in a PML series should be considered associated with each other if they occur simultaneously, overlap, or where there is less than 5 seconds between the end of one event and the onset of the other event regardless of which is first

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11
Q

What is ALMA

A

ALMA is alternate movements between legs. The range of duration is 100-500 µs. It has no clinical consequence

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12
Q

Define Hypnogogic foot tremor

A

Hypnogogic foot tremor requires a train of 4 bursts
The minimum frequency is 0.3 Hz
Maximum frequency is for hertz
The duration is 250-1000 µs

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13
Q

What is excessive fragmentary myoclonus (EFM)

A

The EMG maximum is 150 µs
At least 20 minutes of non-REM sleep with EFM must be recorded
At least 5 EMG potentials per minute must be recorded

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14
Q

How is bruxism scored

A

EMG must be twice the background.
Elevations of EMG activity are 0.25-2 seconds in duration and 3 such elevations months occur in regular sequence
Sustained elevation of chin or masseter EMG are scored as bruxism if lasting more than 2 seconds
Sustained elevations of chin or masseter EMG her score is bruxism that the duration is more than 2 seconds
Bruxism can be scored reliably by audio and combination with polysomnography by minimum of 2 audible tooth grinding episodes per night of polysomnography C in the absence of epilepsy

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15
Q

How is REM sleep behavior disorder scored on PSG

A

Sustained tonic activity in REM sleep An episode of REM sleep with at least 50% of the duration of the affect having a chin amplitude greater than the minimum amplitude demonstrated in NREM sleep

Excessive transient muscle activity (phasic activity) and REM sleep in the 30 second epoch of REM sleep divided into 10 sequential 3 second mini epochs
At least 50% of the mini epochs contain bursts of transient muscle activity. In REM behavior disorder excessive transient muscle activity bursts are 0.1-5 seconds in duration at least 4 times as high amplitude as the background EMG activity

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16
Q

Score rhythmic movement disorder

A

The minimum frequency for scoring rhythmic movements is 0.5 Hz
The maximum frequencies for scoring rhythmic movements is to hertz
The minimum number of individual movements required to make a cluster of rhythmic movements is four movements
The minimal amplitude of individual rhythmic bursts is 2 times the background of background EMG activity

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17
Q

Prevalence of RLS

A

Problems of our LS in European in North American population studies is 5-10%.
Problems his twice as high in women as men
Prevalent increases with age up to 60-70.
No age related problems has been found in Asians
Clinically significant ROS is 2-3% in Europe
Incidents rates are 0.8% to 2.2%
In kidney disease prevalence is 5 times higher than population

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18
Q

What is the genetic influence in RLS

A

BTBD9 confers a risk of 50% for RLS

BTBD9, TOX3/BC034767, MEIS1, MAP2K5/SKOR1, and PTPRD

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19
Q

Treatment of nocturnal leg cramps

A

Night leg cramps usually involve your calf muscles, although muscles in your feet or thighs might cramp as well. Forcefully stretching the contracted muscle relieves the pain.
7% children /33% over 60/ 50% over 80

20
Q

Define benign sleep myoclonus of infancy

A

Benign sleep myoclonus of infancy is characterized by repetitive myoclonic jerks that occurred during sleep apnea made some movements. Georgia often bilateral and massive typically involving large muscle groups. Occur from birth to 6 months of age
There are four jerks lasting 40-300 milliseconds

21
Q

What rules define Alternating Leg Muscle Activation (ALMA):

A

– There must be  4 muscle bursts
– The frequency must be  0.5 Hz (this means the maximum interval
between bursts is 2 sec)
– The frequency must be < 3 Hz (this means the minimum interval between
bursts is 0.3 sec)
– The pattern of ALMA is an EMG burst from one leg and then the other

22
Q

What rules define Hypnagogic Foot Tremor (HFT):

A

The following rules define Hypnagogic Foot Tremor (HFT):
– There must be  4 muscle bursts
– The frequency must be  0.3 Hz (this means the maximum interval
between bursts is 3 sec)
– The frequency must be < 4 Hz (this means the minimum interval
between bursts is 0.25 sec)

23
Q

What rules define Excessive Fragmentary Myoclonus (EFM):

A

EFM normally occurs during NREM sleep
– The usual maximum duration is 150 msec
– There must be  20 minutes of NREM sleep with
EFM
– There must be  5 EMG potentials/minute

24
Q

What rules define bruxism:

A

– Bruxism may consist of brief (phasic) or sustained
(tonic) chin EMG activity that is at least twice the
amplitude of background EMG.
– Bursts of chin EMG activity are scored as bruxism
if:
• they are 0.25 - 2 seconds in duration and
• if  3 elevations occur in a regular sequence

25
Q

What rule defines the PSG characteristics of

Rhythmic Movement Disorder:

A

– The frequency of EMG bursts is ≥ 0.5 Hz.
– The frequency of EMG bursts is < 2.0 Hz.
– The number of individual movements is ≥ 4 movements.
– The amplitude of a rhythmic EMG burst is ≥ 2 times
background EMG activity

26
Q

When do you not score LM

A

Do not score an LM if
– it occurs period of 0.5 sec before or after an apnea,
hypopnea, RERA, or sleep-disordered breathing event
• Arousal and PLM are considered associated in the
case of the following:
1. occur simultaneously
2. <0.5 sec bw offset and onset of each other
3. which comes first does not matter

27
Q

are Frequent PLMS associated with afib progression

A

• Retrospective study
• 373 patients with afib and suspected RLS with PSG
• PLMS > 35/hr vs < 35/hr
• Results
– Permanent afib conversion more likely in PLMS <35
(23% vs. 34%; p=0.01)
– PLMS remained a significant predictor on multivariate
analysis
• (independent predictors = female gender, hypertension)
– A subgroup (n = 153) treated with dopaminergics
• Reduced risk of progression
– 11.6% progression in the treated group versus 32% in untreated

28
Q

What are Substances to Avoid

A 
• Nicotine
• Caffeine
• TCA’s &amp; SSRI’
s
• Antihistamines
• Alcohol
• Reglan &amp; Compazine
• Antipsychotics
29
Q

What illnesses associated with RLS

A

A. Diabetes
B. Cardiovascular diseases
C. Depression and anxiety disorders

30
Q

Genes with RLS

A

2 MEIS1 rs2300478 G 1.68 (1.57-1.81)
6 BTBD9 rs9357271 T 1.47 (1.35-1.47)
9 PTPRD rs1975197 A 1.29 (1.19-1.40)
15 Map2K5/SKOR1 rs12593813 G 1.41 (1.32-1.52)
2 Intergenic region rs6747972 A 1.23 (1.16-1.31)
2 Intergenic region rs2116050 G 1.22 (1.15-1.30)
16 TOX3/BC034767 rs3104767 G 1.35 (1.27-1.43)
16 TOX3/BC034767 rs3104788 T 1.33 (1.25-1.43

31
Q

What are some compulsive behaviors associated with rx of RLS

A

Binge Eating
Interests in Casino Slot Machine Use
Compulsive Shopping
Medication hoarding
Hypersexuality (i.e., increased experimentation with spouse; increased pornography viewing)
Refusal to wear seat-belt despite traffic citations
Increased speeding while driving car
Increased garage sale visits
New and increased participation in costume play
Increased make-up and dress for casual outings
Need to see broadway shows in New York despite same shows playing in hometown
Increased need to cover co-worker shifts (despite going part time)

32
Q

Describe periodic leg movements

A

Periodic leg movements are scored only if they are part of a series of four or more consecutive movements lasting .5 to 10 seconds with an inter-movement interval of 5 to 90 seconds and amplitude greater than 8 µV above the baseline EMG. PLM’s cluster into episodes that are more numerous in the first half of the night but recur throughout the night. 1/3 of all POS associated with arousal.Almost every PLM is associated with tachycardia and bradycardia. There is also significant increase blood pressure 22 mm Hg and 11 mmHg.

33
Q

What is the

A

The patient remains in bed reclined in a 45° angle with legs outstretched and eyes open. They are asked to avoid moving voluntarily for the entire duration of the test. EMG is recorded on the anterior tibialis. The patient is asked every five minutes how uncomfortable they are.

34
Q

What is the international restless leg syndrome study group rating scale

A

A scale to measure the severity of RLS

35
Q

What is the association between AHD and PMLS

A

26% to 64% of children with ADHD Have a PMLs index greater than five per hour44% of children with PLMs have ADHD

36
Q

What is a side effect of Sinemet treatment for PMLS

A

Augmentation and the morning rebound.Higher doses are associated with larger augmentation effects

37
Q

What is the effectiveness of pramiprexole

A

Augmentation occurs in about 32% of the patients. The drug is effective in about 82% of patients. There can be increase impulses and in time spent gambling and increase sexual desire.
Rotigotine patch is also effective

38
Q

How are opioids used in PLMS

A

They are effective but limited by Addicton

39
Q

What is the role of iron therapy

A

When the ferritin level is less than 45 to 50 µg, then how are treatment is indicated.

40
Q

What is the effect of estrogen on RLS

A

estrogen may alleviate hot flashes, but could exacerbate potential restless legs syndrome

41
Q

In the evaluation of patients with RLS, how often should you expect to find a positive family history of RLS?

A

occurs in over 50% of cases

42
Q

What are periodic leg movements (PLM) during sleep in narcolepsy?

A

narcolepsy patients show a high number of limb movements that are significantly less periodic than those of patients with restless leg syndrome

43
Q

The highest rhythmic masticatory muscle is observed during which of the following sleep stages:

A

stage N2

44
Q

What drug to use in people with renal disease and RLS

A

Ropinirole has been shown to be effective in hemodialysis patients (Pellechia et al. and Giannaki et al.), and it is hepatically metabolized, which is preferable in the setting of renal failure. Based on Pellacchia et al., it is likely more effective than levodopa. Both gabapentin and pramipexole are excreted in the urine largely as unchanged drug and have greater potential to accumulate in renal failure patients, thus incurring a greater risk of side effects.

45
Q

What is prevalence of RLS

A

RLS is a common disorder seen in 5-10% of the populations from Northern European decent.

Similar prevalence in boys & girls; higher prevalence in women only after age 20.

Prevalence for those severe enough to warrant medical attention is estimated to be around 2.7%.

Risk of RLS also increases with the number of children a woman has as depicted by this table (using men with odds ratio reference of 1). Women who have 3 or more children will be over 3.5 x more at risk for developing RLS compared to men.

46
Q

What is effect of pregnancy on RLS

A

20 to 25% of pregnant women experience RLS

If new onset (more than half), generally occurs in 2nd or third trimester

Symptoms may stop soon after delivery

Speculated etiologies include iron deficiency, folate deficiency, hormonal changes

May be risk factor for later development of RLS

47
Q

What are treatments of RLS in pregnancy

A

Case reports suggests that the risk is minimal; pregnant women treated with ropinirole, pramiprexole and gabapentin for other indications have not had excess defects. Opioids have been associated with more fetal complications and are not recommended.

sleep movement disorder (1 decks)

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