节律性运动障碍1例并文献复习.docVIP

节律性运动障碍1例并文献复习【摘要】 目的 了解节律性运动障碍(rhythmic movement disorder,RMD)的临床表现、诊断和治疗,减少误诊误治。方法 报告1例RMD患者的临床资料并复习文献。结果 RMD是一种与睡眠相关的运动障碍,婴幼儿多见,青春期和成年罕见。临床主要表现为撞头、摇头或身体摆动,以撞头最常见,少数累及肢体,患者有一种或一种以上的运动形式,运动频率0.5~2 Hz,每次发作持续数分钟~15 min,每晚发作数次至10余次,易与夜间癫痫发作混淆,多导睡眠图监测能帮助诊断,对小剂量氯硝安定治疗敏感。结论 RMD并非罕见,提高认识是减少误诊误治的关键。 【关键词】 节律性运动障碍;撞头;睡眠;误诊 Rhythmic movement disorder:A case report and Literature review LI Zhen-dong,KOU Li,ZHEN Jun,et al. Department of Neurology,The Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China 【Abstract】 Objective To understand clinical manifestation,diagnosis and treatment of rhythmic movement disorder(RMD)for reducing diagnostic errors and mistreatments.Methods A case of RMD was reported and the relative literature was reviewed.Results RMD is a sleep related motor disorder that is common in infants and toddlers,but persistence into the teens and the adults is rare.Its common clinical manifestation are head banging,head rolling and body rocking,which head banging is most common.Less commonly,limbs may be involved.Patients may also present with a combination of the above movements.The frequency of movement ranges from 0.5 to 2 Hz and the duration can be up to several minutes~15 minutes.The frequency of attack is several times~more than 10 times in one night.The attack is confused easily as nocturnal epilepsy.Polysomnography can help to identify RMD.RMD is sensitive to small dose of clonazepam.Conclusion RMD is by no means infrequent.It is capital to strengthen cognition of RMD for reducing misdiagnosises and mistreatments. 【Key words】 Rhythmic movement disorder; Head banging; Sleep; Misdiagnosis 节律性运动障碍(rhythmic movement disorder,RMD)是一种并不少见的临床现象,但是由于缺乏认识,国内少见报道和研究,也容易误诊为其他疾病。本文报道1例并复习国外文献,以增加对RMD的了解,减少误诊误治。 1 病例摘要 男性16岁,初中二年级学生,因反复发生睡眠中撞头和摇头11年于2009年7月9日住院。患者自5岁开始间断发作睡眠中前额撞击枕头和向一侧摇头,撞头时呈俯卧位,摇时呈仰卧位,每次持续3~5 min,可连续4~10次,偶伴一侧上肢拍击床面,有时摇头碰到墙壁能撞伤头皮或者惊醒床伴,当时不易唤醒,发作过后继续睡眠,醒后不能回忆经过。通常晚9时入睡,11时至凌晨4时之间发作,当夏季或在闷热环境中每天发作,凉爽天气或环境时偶而发作。