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렘수면행동장애 환자의 수면다원검사에 대한 정량적 분석을 통한 진단적 접근
박석경,신동진,박현미,이영배,신동훈,박기형 대한수면연구학회 2012 Journal of sleep medicine Vol.9 No.2
Rapid eye movement sleep behavior disorder (RBD) is characterized by the intermittent absence of electromyogram (EMG) atonia during rapid eye movement (REM) sleep and the increase of motor activity associated with dream mentation. However, ICSD-2 criteria did not suggest validated diagnostic criteria and previous studies had no consistency with value ranged 10-20% of REM sleep without atonia (RSWA) in polysomnography (PSG). We investigated standard value about RSWA of Korean RBD patients. Methods: Thirty one patients diagnosed with RBD and 31 normal age- and sex-matched controls were selected. All RBD patients and normal controls were studied using PSG from 2007 to 2012. ICSD-2 criteria was used to select RBD patients and RSWA. We defined RSWA as increasing amplitude by 4 times that of baseline EMG and occupying at least 50% of each epoch or five 3 second mini-epochs. Results: PSG findings showed increased N1 sleep, periodic leg movement index and decreased N2 sleep in RBD patients compared to normal controls. Mean RSWA was 19.21% [±9.93, standard deviation (SD)], with a range of 5.21-38.22% in RBD patients, whereas the mean RSWA in normal control was 0.43% (±0.74, SD) with a range of 0-2.3%. Conclusions: We quantitatively figured out the characteristics of PSG and RSWA in Korean RBD patients. The outcome shows definite differences between RBD patients and normal controls. This study suggest that we may diagnose RBD who have RSWA over 5% of the REM sleep periods.
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A Case of Cluster Headache Accompanied by Myoclonus and Hemiparesis
양지원,박석경,정인혜,성영희,박기형,이영배,신동진,박현미 대한신경과학회 2012 Journal of Clinical Neurology Vol.8 No.1
Background Cluster headache is a primary headache disorder characterized by periodic episodes of intense headache accompanied by autonomic symptoms. We report an unusual clinical presentation of cluster headache that was preceded by myoclonus and accompanied by hemiparesis. Case Report A 26-year-old man visited hospital due to recurrent jerky movements on the left side of his face and neck area lasting 3 days. These jerky movements had disappeared spontaneously without specific treatment. On the 10th day after onset of the jerky movements, the patient developed a series of unilateral severe headaches that were accompanied by autonomic symptoms lasting 1-2 hours. According to the second edition of The International Classification of Headache Disorders, he was diagnosed as having cluster headache. Two of the 16 severe headache attacks this patient suffered were accompanied by dysarthria and hemiparesis. Electroencephalography performed during hemiparesis revealed diffuse lateralized slow activity on the ipsilateral hemisphere of the headache side. The headache and accompanying hemiparesis disappeared after medical treatment for cluster headache. Conclusions We describe a case of cluster headache accompanied by hemiparesis, which was preceded by myoclonus. We also outline the possible mechanisms underlying this case.
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