[Sleep in a case of hemiballism]

Abstract

Sleep spindles abnormalities in extrapyramidal disorders have already been reported, but in the unilateral syndromes the data are unclear and inconclusive. In the attempt to clarify the problem we describe nocturnal sleep in a patient with hemiballism due to an ischemic damage of the subthalamic nucleus. The patient improved after one month haloperidol therapy and her unilateral (right) hyperkinesias disappeared. Electropolygraphic records (EEG, EOG, EMG of chin muscles, ECG) during spontaneous nocturnal sleep were obtained before therapy and after one month haloperidol treatment. The EEGs from bilateral fronto-central derivations were also recorded on magnetic tape to allow spectral analysis and automatic spindle detection by means of digital filtering. The pattern of spindle appearance rate for each stage 2 and 3 NonREM sleep in each night was investigated. We obtained: spindling index, that is the ratio between total spindle duration and sleep stage length, the mean number of spindle bursts/min, the average duration of sleep spindles, the mean amplitude, the mean time between spindles. Before therapy polygraphic records showed short total sleep time, a prolonged sleep latency, the lack of slow waves sleep and of REM sleep. After haloperidol treatment these parameters improved: total sleep time was longer, sleep latency shorter, slow waves sleep and REM sleep appeared. Before treatment spindle activity predominated in the left hemisphere - homolaterally to the subthalamic nucleus damage -, where the spindling index was higher, the mean number of spindle bursts/min larger, the mean time between spindles lower. After therapy, when hemisomatic hyperkinesias disappeared, spindle activity turned similar in the two hemispheres, since it decreased in the left hemisphere and it was unchanged in the right one.(ABSTRACT TRUNCATED AT 250 WORDS)