Yukio Fukuyama

Polygraphic Study during Whole Night Sleep in Infantile Spasms

The whole night EEG were polygraphically recorded and analyzed in 9 patients with infantile spasms prior to ACTH therapy. The subjects were divided into two groups, favorable and unfavorable, depending upon the response to the ACTH therapy. (1) Among the unfavorable group, the deep sleep stage was not observed; while the light sleep stage tended to dominate. (2) REM sleep period was noted less among the unfavorable than among the favorable group. REM density also tended to be lower among the unfavorable group. (3) Of the 4 unfavorable cases, 2 did not manifest REM sleep at all. Of the remaining 2, 1 had a remarkably long REM interval period. Even among the favorable cases, REM sleep tended to be short and appear frequently. (4) The period of muscle atonia during NREM sleep was markedly prolonged in all cases. (5) Body movements of both types (gross and twitch) were less frequent comparing to those of normal younger children, more remarkably in unfavorable cases. From the above findings, a disorder of the pontine reticular formation would be suggested in cases of infantile spasms. Reduction of body movements at each sleep stage might indicate abnormalities of monoamine metabolism in the brain stem of patients with this condition.

Sleep Electroencephalograms and Sleep Stages in Hypoparathyroidism

2 patients with hypoparathyroidism, one idiopathic and the other pseudoform, were studied by overnight polygraphic recording of the sleep EEG and related activities before and after start of treatment to investigate their sleep EEG patterns and states, with the results as follows. (1) Conspicuous abnormalities were noted in the sleep record, namely, disappearance of humps, spindles and hill waves, emergence of the mitten pattern and rather monotonous delta rhythm bursts. The EEGs, both awake and asleep, showed findings suggestive of a possible disorder of the desynchronizing mechanism of the brain stem. Normal sleep EEG patterns were restored after the serum calcium level had returned to the normal range. (2) In the course of overnight sleep, disturbance in the cyclic changes of sleep EEG pattern and absence of REM sleep were observed. Restoration to the normal course of sleep was achieved following the normalization of serum calcium level. Divalent calcium ion is considered to have intimate bearing upon the mechanism whereby synaptic chemical transmitters are activated. When viewed with reference to the monoamine hypothesis of Jouvet, the disturbance in the course of sleep observed in the present cases, especially the absence of or disturbed REM sleep, is inferred to be related to the hypocalcemia.