National Hospital for Neurology and Neurosurgery, Epilepsy Department, Queen Square, London, UK.
Sleep. 2013 Feb 1;36(2):287-90. doi: 10.5665/sleep.2392.
We report the case of a 43-year-old woman presenting with nocturnal episodes of pain and screaming during sleep starting at age 30. There was no childhood or family history of parasomnia. The events had gradually become more frequent over the years, occurring in the first half of the night within 2 h of sleep onset. There were no triggers, and she had partial amnesia for the events. A diagnosis of adult-onset sleep terrors was made on clinical grounds and supported polysomnographically. Seizures and periodic limb movements were excluded as triggering factors. There was some mild sleep disordered breathing (predominantly non-desaturating hypopnea with a propensity for REM sleep of debatable significance). Imaging of the brain and spine and neurophysiological investigations ruled out lesions, entrapments, or neuropathies as possible causes of pain. Treatment (clonazepam, paroxetine, or gabapentin) was poorly tolerated and made no difference to the nocturnal episodes, while trazodone worsened them. This is the first report of hypnopompic psychic pain in association with a NREM parasomnia. We hypothesize that the pain may represent a sensory hallucination analogous to the more commonly recognized visual NREM parasomnia-associated hypnopompic visual hallucinations and that, as such, it may arise during arousal of the sensory neocortex as confabulatory response.
我们报告了一例 43 岁女性的病例，她从 30 岁开始出现夜间睡眠时疼痛和尖叫的发作，无睡眠障碍的家族史。这些事件近年来逐渐变得更加频繁，发生在睡眠开始后 2 小时内的前半夜。没有诱因，而且她对这些事件只有部分记忆。根据临床症状和多导睡眠图，诊断为成人发作性睡惊症。排除了癫痫发作和周期性肢体运动作为触发因素。存在一些轻度的睡眠呼吸紊乱（主要是非缺氧性呼吸暂停，伴有 REM 睡眠的倾向，但意义不大）。脑和脊柱的影像学检查以及神经生理学研究排除了病变、压迫或神经病变可能是疼痛的原因。治疗（氯硝西泮、帕罗西汀或加巴喷丁）效果不佳，对夜间发作没有影响，而曲唑酮则使发作加重。这是首例与非快速眼动睡眠障碍相关的催眠性精神痛的报告。我们假设疼痛可能代表一种感觉幻觉，类似于更常见的视觉非快速眼动睡眠障碍相关的催眠性视觉幻觉，并且，它可能是作为一种虚构反应，在感觉新皮质的觉醒过程中出现。
