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Sleep disorder in alien hand syndrome.
J J Ortega-Albás1, M de Entrambasaguas, F J Montoya
1Sleep Unit, Department of Clinical Neurophysiology, Hospital General de Castellón, Avenida de Benicàssim s/n, E-12004 Castellón, Spain. ortega_jua@gva.es
Sleep Medicine
|November 1, 2003
Summary
Alien Hand Syndrome (AHS) involves involuntary movements of a hand, often occurring during wakefulness after a stroke. This case highlights AHS movements emerging from specific sleep stages, suggesting novel neurological control mechanisms.
Area of Science:
- Neuroscience
- Neurology
- Sleep Medicine
Background:
- Alien Hand Syndrome (AHS) is a rare neurological disorder characterized by a perceived lack of control over a limb.
- Stroke, particularly involving the anterior cerebral artery, can precipitate AHS, leading to significant patient distress and functional impairment.
Observation:
- A 63-year-old woman with a left anterior cerebral artery infarction developed AHS with prominent daytime motor activity.
- Polysomnography revealed that these involuntary movements occurred exclusively during wakefulness, often emerging from NREM sleep stage 2.
- No epileptiform activity, dyssomnia, or parasomnia were identified, differentiating AHS from other sleep-related movement disorders.
Findings:
- The alien hand movements in this patient were strictly associated with the awake state, despite initial concerns about sleep disturbance.
- The temporal pattern of motor activity suggested a link to the natural hyperpolarization of anterior horn neurons during sleep progression.
- The grasp reflex accommodation appeared to play a role in managing the unwanted motor activity.
Implications:
- This case expands the understanding of AHS pathophysiology, suggesting a complex interplay between cortical and subcortical structures.
- The findings underscore the importance of detailed polysomnographic evaluation to differentiate AHS from other movement disorders, especially those affecting sleep.
- Further research into the neural mechanisms underlying AHS could lead to targeted therapeutic strategies for motor control disorders.