Rubboli G, d'Orsi G, Zaniboni A, Gardella E, Zamagni M, Rizzi R, Meletti S, Valzania F, Tropeani A, Tassinari C A
Department of Neurological Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3 - 40139, Bologna, Italy.
Clin Neurophysiol. 2000 Sep;111 Suppl 2:S120-8. doi: 10.1016/s1388-2457(00)00412-0.
To perform a video-polygraphic analysis of 11 cataplectic attacks in a 39-year-old narcoleptic patient, correlating clinical manifestations with polygraphic findings. Polygraphic recordings monitored EEG, EMG activity from several cranial, trunk, upper and lower limbs muscles, eye movements, EKG, thoracic respiration.
Eleven attacks were recorded, all of them lasting less than 1 min and ending with the fall of the patient to the ground. We identified, based on the video-polygraphic analysis of the episodes, 3 phases: initial phase, characterized essentially by arrest of eye movements and phasic, massive, inhibitory muscular events; falling phase, characterized by a rhythmic pattern of suppressions and enhancements of muscular activity, leading to the fall; atonic phase, characterized by complete muscle atonia. Six episodes out of 11 were associated with bradycardia, that was maximal during the atonic phase.
Analysis of the muscular phenomena that characterize cataplectic attacks in a standing patient suggests that the cataplectic fall occurs with a pattern that might result from the interaction between neuronal networks mediating muscular atonia of REM sleep and neural structures subserving postural control.
对一名39岁发作性睡病患者的11次猝倒发作进行视频多导睡眠图分析，将临床表现与多导睡眠图结果相关联。多导睡眠图记录监测脑电图、来自多个头颅、躯干、上肢和下肢肌肉的肌电图活动、眼球运动、心电图、胸式呼吸。
记录到11次发作，所有发作持续时间均少于1分钟，均以患者倒地结束。根据对这些发作的视频多导睡眠图分析，我们确定了3个阶段：初始阶段，主要特征为眼球运动停止以及阶段性、大量、抑制性肌肉事件；跌倒阶段，特征为肌肉活动抑制和增强的节律模式，导致跌倒；弛缓性麻痹阶段，特征为完全性肌肉弛缓。11次发作中有6次伴有心动过缓，在弛缓性麻痹阶段最为明显。
对站立患者猝倒发作特征性肌肉现象的分析表明，猝倒跌倒的发生模式可能是由介导快速眼动睡眠肌肉弛缓的神经网络与维持姿势控制的神经结构之间相互作用导致的。
