Kowacs Pedro A, Teive Hélio A Ghizoni, Piovesan Elcio J, Zavala Jorge A, Werneck Lineu C
Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brasil.
Arq Neuropsiquiatr. 2006 Dec;64(4):1027-9. doi: 10.1590/s0004-282x2006000600028.
Sleep disorders presenting involuntary movements may be very annoying to patients, apart from their negative influence on sleep.
To report the use of botulinum type-A toxin (BoNT-A) to manage the case of a patient whose sleep was severely disrupted by episodes of dystonic posturing of the right lower limb triggered by periodic limb movements of sleep (PLMS).
A 79-year-old woman with mild post-stroke right hemiparesis presented with recurrent painful episodes of dystonia of the right lower limb, which disrupted her sleep. The dystonic episodes could also be voluntarily triggered by extension of the right hallux. Polysomnography confirmed that the dystonic episodes were triggered by PLMS. Twenty units of BoNT-A (20U/500U vial) were injected into her right extensor hallucis longus.
Shortly after BoNT-A was injected, the dystonic symptoms abated, and the patient achieved better sleep efficiency.
The PLMS-related involuntary extension of the hallux was probably triggering the nocturnal post-stroke lower limb dystonic paroxysms. BoNT-A injection into the right extensor hallucis longus was effective in managing this condition and thus resolved the associated disruption of sleep.
除了对睡眠有负面影响外，伴有不自主运动的睡眠障碍可能会让患者非常苦恼。
报告使用A型肉毒杆菌毒素（BoNT-A）治疗一名患者的情况，该患者的睡眠因睡眠期周期性肢体运动（PLMS）引发的右下肢肌张力障碍姿势发作而严重中断。
一名79岁轻度中风后右侧偏瘫女性，出现右下肢反复疼痛性肌张力障碍发作，扰乱了她的睡眠。右拇趾伸展也可自发引发肌张力障碍发作。多导睡眠图证实肌张力障碍发作由PLMS引发。将20单位BoNT-A（20U/500U小瓶）注射到她的右拇长伸肌。
注射BoNT-A后不久，肌张力障碍症状减轻，患者睡眠效率提高。
与PLMS相关的拇趾不自主伸展可能引发了中风后夜间下肢肌张力障碍发作。向右拇长伸肌注射BoNT-A有效治疗了这种情况，从而解决了相关的睡眠中断问题。
