Department of Neurology (and Sleep Center), Changhua Christian Hospital-Yun Lin Branch and St Martin de Porres Hospital, Chiayi, Taiwan.
J Clin Sleep Med. 2012 Aug 15;8(4):403-11. doi: 10.5664/jcsm.2034.
To describe three cases of sleep related, idiopathic rhythmic movement disorder (RMD) with atypical headbanging, consisting of head punching and head slapping.
Three consecutive patients (2 males [11 and 13 years old) and one female [22 years old]) presented with atypical headbanging of 6 years, 7 years, and 17 years duration. In 2 cases, typical rhythmic headbanging (with use of the head) shifted after 3-4 years to atypical headbanging, with frontal head punching that was quasi-rhythmic. In one case, atypical headbanging (head-slapping) was the initial and only RMD. There was no injury from the headbanging. Prenatal, perinatal, developmental, behavioral-psychological, medical-neurological, and family histories were negative. Clinical evaluations and nocturnal video-polysomnography with seizure montage were performed on all patients.
Atypical headbanging was documented in all 3 cases; episodes always emerged late in the sleep cycle: from N2 sleep in 11 episodes, from REM sleep in 4 episodes, and from N1 sleep in 1 episode. Epileptiform activity was not detected. Clonazepam therapy was substantially effective in 1 case but not effective in 2 cases.
These 3 cases of idiopathic atypical headbanging expand the literature on this RMD variant, as to our knowledge only one previously documented case has been reported.
描述 3 例与睡眠相关的特发性节律性运动障碍（RMD）病例，表现为非典型的摇头，包括头部撞击和拍打。
连续 3 例患者（2 例男性[年龄分别为 11 岁和 13 岁]和 1 例女性[年龄为 22 岁]）出现非典型摇头，持续时间分别为 6 年、7 年和 17 年。在 2 例病例中，典型的节律性摇头（头部使用）在 3-4 年后转变为非典型的头部撞击，呈准节律性。在 1 例病例中，非典型的摇头（拍打头部）是最初和唯一的 RMD。头部撞击没有造成伤害。所有患者均进行了临床评估和包含癫痫发作模式的夜间视频多导睡眠图检查。
3 例患者均出现非典型的摇头，发作始终出现在睡眠周期的晚期：11 例出现在 N2 睡眠期，4 例出现在 REM 睡眠期，1 例出现在 N1 睡眠期。未检测到癫痫样活动。氯硝西泮治疗在 1 例患者中效果显著，但在 2 例患者中无效。
这 3 例特发性非典型摇头病例扩展了关于这种 RMD 变异的文献，因为据我们所知，此前仅报道过 1 例病例。
