Disconnection between periodic leg movements and cortical arousals in spinal cord injury.
OBJECTIVE
In this study we examine the temporal connection between periodic leg movements (PLMs) and cortical arousals, as well as the treatment effect of pramipexole, in a clinical case with spinal cord lesion.


METHODS
A patient with complete cervical spinal cord injury and PLMs during sleep underwent two baseline sleep recordings, one recording with dopaminergic treatment, and one recording with adaptive servoventilation.


RESULTS
The PLMs were temporally dissociated from cortical arousals as well as from respiratory or heart rate events. PLMs were suppressed by pramipexole and persisted after treatment of apnea.


CONCLUSIONS
The disconnection of PLMs from arousals supports a spinal generator or peripheral trigger mechanism for PLMs. The suppression of movements by a dopamine agonist suggests that its site of action is caudal to the cervical lesion and outside of the brain. Our observation provides significant new knowledge about the pathogenesis of PLMs and warrants studies in larger populations.
University of Tampere, School of Medicine, Tampere, Finland ; Unesta Research Centre, Tampere, Finland.
Aaro V
AV
Salminen
Mauro
M
Manconi
Ville
V
Rimpilä
Teemu M
TM
Luoto
Eerika
E
Koskinen
Raffaele
R
Ferri
Juha
J
Ohman
Olli
O
Polo
D000328:Adult; D001143:Arousal / Q000502:physiology*; D052160:Benzothiazoles / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D008297:Male; D020189:Nocturnal Myoclonus Syndrome / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D000077487:Pramipexole; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology
D052160:Benzothiazoles; D018491:Dopamine Agonists; D000077487:Pramipexole
Periodic leg movements; case report; cortical arousal; dopamine agonist; sleep apnea; spinal cord injury