title: Bilateral paramedian thalamic syndrome: abnormal circadian wake-sleep and autonomic functions.
abstract: OBJECTIVE
  To describe wake-sleep and body core temperature (t degrees ) rhythm abnormalities in two patients with bilateral paramedian thalamic calcifications.
  
  
  METHODS
  Patients underwent (18F)FDG PET scans and 24 hour polygraphic recordings of wake-sleep and t degrees.
  
  
  RESULTS
  PET showed bilateral thalamic hypometabolism in both patients with additional basal ganglia or mesiolateral frontal and cingular hypometabolism. Wake-sleep studies showed abnormal sleep organisation and in the case with frontal and limbic PET hypometabolism, pre-sleep behaviour associated with "subwakefulness" EEG activities, lack of EEG spindles and K complexes, and features of status dissociatus. The t degrees rhythms showed increased mesor in both (37.4 degrees C and 37.75 degrees C) and inverted rhythm in one patient.
  
  
  CONCLUSIONS
  Paramedian thalamic structures and interconnected, especially frontal and cingular, areas play a part in the organisation of the wake-sleep cycle and attendant autonomic functions.
authors.affiliation: Institute of Clinical Neurology, University of Bologna Medical School, Bologna, Italy. pmontagn@neuro.unibo.it
authors.forename: P
authors.initials: P
authors.lastname: Montagna
authors.forename: F
authors.initials: F
authors.lastname: Provini
authors.forename: G
authors.initials: G
authors.lastname: Plazzi
authors.forename: R
authors.initials: R
authors.lastname: Vetrugno
authors.forename: R
authors.initials: R
authors.lastname: Gallassi
authors.forename: G
authors.initials: G
authors.lastname: Pierangeli
authors.forename: M
authors.initials: M
authors.lastname: Ragno
authors.forename: P
authors.initials: P
authors.lastname: Cortelli
authors.forename: D
authors.initials: D
authors.lastname: Perani
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001833:Body Temperature Regulation / Q000502:physiology; D002114:Calcinosis / Q000175:diagnosis* / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology; D004292:Dominance, Cerebral / Q000502:physiology*; D004734:Energy Metabolism / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional; D009483:Neuropsychological Tests; D017286:Polysomnography; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis* / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology; D013577:Syndrome; D013786:Thalamic Diseases / Q000175:diagnosis* / Q000503:physiopathology; D013788:Thalamus / Q000503:physiopathology; D014055:Tomography, Emission-Computed