Lee M S, Choi Y C, Lee S H, Lee S B
Department of Neurology, Youngdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Mov Disord. 1996 Nov;11(6):719-22. doi: 10.1002/mds.870110619.
We describe three patients who developed progressive paraparesis and sleep-related periodic leg movements (SRPLM) associated with thoracic spinal cord lesions; one patient had a schwannoma and two had intramedullary lesions. The patients showed periodic repetitive involuntary movements involving one or both lower limbs. The involuntary movements consisted of a single rapid dorsiflexion of the great toe or ankle, two to four repetitive dorsiflexions of the toes and ankle, and a mixture of repetitive jerks and prolonged spasms causing flexion of the hip and knee and dorsiflexion of the ankle and toes. In the patient with a schwannoma, paraparesis and SRPLM improved completely after surgical removal of the mass lesion. In one patient the SRPLM associated with an intramedullary lesion improved markedly after levodopa treatment. We suspect that thoracic spinal lesions partially disinhibit the lumbosacral generator. Such disinhibition seems to be enhanced by the activation of the neuronal systems related to periodic somatic and vegetative phenomena during sleep.
我们描述了三名出现进行性截瘫以及与胸段脊髓病变相关的睡眠相关性周期性腿部运动（SRPLM）的患者；一名患者患有神经鞘瘤，两名患者患有髓内病变。这些患者表现出涉及一侧或双侧下肢的周期性重复性不自主运动。不自主运动包括大脚趾或踝关节的单次快速背屈、脚趾和踝关节的两到四次重复性背屈，以及重复性抽搐和持续性痉挛的混合，导致髋部和膝部屈曲以及踝关节和脚趾背屈。在患有神经鞘瘤的患者中，手术切除肿块病变后截瘫和SRPLM完全改善。在一名患者中，与髓内病变相关的SRPLM在左旋多巴治疗后明显改善。我们怀疑胸段脊髓病变部分抑制了腰骶部发生器。在睡眠期间，与周期性躯体和植物神经现象相关的神经元系统的激活似乎增强了这种去抑制作用。
