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Sleep features in Tourette's syndrome, neuroacanthocytosis and Huntington's choreaSyndrome de Gilles de la Tourette

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Summary

Twenty-one patients affected by extrapyramidal disorders were polygraphically recorded during spontaneous nocturnal sleep for two consecutive nights to assess their sleep and movement patterns. The patients (pts) sample included: Gilles de La Tourette syndrome (TS, nine pts), neuroacanthocytosis (NA, six pts) and Huntington's chorea (HC, six pts). Sleep recording included C3/A2, 01/A2, ROC/LOC, submental EMG, EKG, nasal airflow thoracoabdominal respirogram, bilateral anterior tibialis and other EMGs, in relation to the individual distribution of the abnormal movements. According to our observations, abnormal movements always decreased but never ceased completely during sleep. Sleep efficiency (SE) was nearly always poor with a high percentage of wakefulness after sleep onset (WASO) and increased number of arousals. REM sleep was often reduced and in some cases (3 TS pts) incompletely defined as far as its microstructural aspects. Slow wave sleep (SWS) was reduced in HC, normal in NA, and increased in all TS patients with the exception of the two adult subjects more severely affected, while the percentage of stage 2 was not affected. Spindling was increased in NA, HC and in the two most severely affected adult TS patients.

Résumé

Vingt et un malades ayant présenté un syndrome pyramidal ont bénéficié d'une polygraphie nocturne pour préciser leur sommeil et étudier leur mouvement. L'échantillon incluait cinq patients présentant une maladie de Gilles de la Tourette (TS), six patients une neuro-acantocytose (nA) et six une Chorée de Huntington (HC). Les enregistrements de sommeil incluaient les dérivations électroencéphalographiques C3-A2, O1-A2, l'électro-oculogramme vertical et horizontal, l'électromyogramme du muscle sous-mentonnier, l'électrocardiogramme, la respiration nasale et thoraco-abdominale, l'électromyogramme des deux muscles tibialis antérior et éventuellement d'autres muscles en fonction de la distribution des mouvements anormaux. Nous avons remarqué que les mouvements anormaux diminuaient toujours et ne cessaient jamais complètement pendant le sommeil. L'efficience du sommeil (SE) était presque toujours diminuée en raison d'un haut pourcentage d'éveil après le début du sommeil et une augmentation du nombre des éveils nocturnes. Le sommeil paradoxal est très souvent réduit et dans quelques cas (trois patients TS) incomplètement défini dans son aspect microstructural. Le sommeil à ondes lentes était réduit dans les HC, normal dans les NA et augmenté chez tous les patients sauf deux adultes affectés sévèrement présentant une maladie de Gilles de la Tourette, alors que le pourcentage de stade II n'était pas modifié. Les fuseaux étaient augmentés dans le NA, la HC, et chez deux des patients les plus sévèrement atteints par une maladie de Gilles de la Tourette.

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