Polysomnography--functional topographical examination of the basal ganglia

Polysomnographical examinations were performed on two cases with unilateral lesion in the basal ganglia. One (case 1) was a 10-year-old girl with tuberous sclerosis with subependymal nodules on the left thalamostriatal sulcus and rotatory seizures, and pharmacologically the existence of a postsynaptic supersensitivity of the dopaminergic (DA) neurons, was suggested. The other (case 2) was an 8-year-old boy with infarction of the left putamen. Two types of body movements (BMs); gross movements (GM) and twitch movements (TM), were evaluated. The mode of occurrence of these BMs against each sleep stage, the pattern of BMs, and the ratio of the number of TM in the mentalis muscle in stage REM against the number of rapid eye movements (REMs) (ment TM REM/REMs) were estimated. The modulation of these parameters by L-Dopa and pimozide was studied. The pattern of GM reflected the DA activity of the side of the lesion. TM of the contralateral side reflected the pathophysiology of the lesion. TM of the ipsilateral extremities of case 1 showed the pattern of DA hyperactivity, which were reduced by small doses of L-Dopa. In case 2, TM of the ipsilateral extremities showed a normal pattern and rate, which increased markedly after L-Dopa. The TM of the sternocleidomastoideus revealed abnormal ipsilaterally in case 1 and contralaterally in case 2. The ment TM REM/REMs ratio reflected the real function of the DA neurons and did not reflect their hyperfunction due to postsynaptic supersensitivity. The numbers and direction of REMs might reflect the function of the basal ganglia, particularly of the DA neurons.