Kohyama J, Ohsawa Y, Shimohira M, Iwakawa Y
Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, Japan.
J Neurol Sci. 1996 Jun;138(1-2):82-7. doi: 10.1016/0022-510x(95)00342-y.
Single polysomnography was performed before treatment in 17 patients with infantile spasms (IS) (13 with a cryptogenic type and 4 with a symptomatic one). Their sleep components during rapid eye movement (REM) sleep were compared with those in 22 age-matched controls. The tonic muscle atonia during REM sleep was observed in all IS patients as in controls. The amount of REM sleep in IS patients was significantly lower, while the incidences of gross movements, phasic chin muscle activity, and bursts of horizontal rapid eye movements were identical with those in controls. The phasic inhibition index (PII), i.e., the rate of simultaneous occurrence of phasic chin muscle activity and bursts of horizontal rapid eye movements, was significantly higher in IS than in controls. The PII value was the only parameter that reflected our patients' prognosis among the obtained REM sleep parameters. We presume that the elevated PII in IS reflects the weakness of the phasic motor activity reduction occurring with horizontal rapid eye movements, and attribute this disturbance to a functional instability of the rostral pontine tegmentum. We propose that PII is a useful parameter for assessing the prognosis of IS. Considering the neural basis for elevated PII in IS, this index is expected to provide a clue for explaining the pathophysiology of IS.
对17例婴儿痉挛症（IS）患者（13例隐源性类型和4例症状性类型）在治疗前进行了单次多导睡眠监测。将他们快速眼动（REM）睡眠期间的睡眠成分与22名年龄匹配的对照组进行比较。与对照组一样，在所有IS患者中均观察到REM睡眠期间的紧张性肌肉弛缓。IS患者的REM睡眠量显著降低，而粗大运动、相位性颏肌活动和水平快速眼动爆发的发生率与对照组相同。相位抑制指数（PII），即相位性颏肌活动和水平快速眼动爆发同时出现的比率，在IS患者中显著高于对照组。PII值是在获得的REM睡眠参数中唯一反映我们患者预后的参数。我们推测IS中升高的PII反映了水平快速眼动时相位性运动活动减少的减弱，并将这种紊乱归因于脑桥被盖前部的功能不稳定。我们提出PII是评估IS预后的有用参数。考虑到IS中PII升高的神经基础，该指数有望为解释IS的病理生理学提供线索。
