Sleep-related eating disorder (SRED) is classified as an NREM-related parasomnia characterized by recurrent episodes of dysfunctional eating that occur after an arousal from the main sleep period with partial or complete amnesia for the event, resulting in weight gain from eating high calorie foods and causing various injuries due to consumption of inedible or toxic items. We report a patient with obesity diagnosed sleep-related eating disorder associated with obstructive sleep apnea (OSA).Insisting on applying ventilator leading to weight loss and clinical improvement. Our case may increase awareness among physicians about sleep-related eating disorders.

We reported a case of narcolepsy type 1 (NT1) and epilepsy comorbidity. A 20-y-old girl appeared sudden limbs shaking and unconsciousness after the diagnosis of NT1 for 5 years. The video-electroencephalographic findings showed abnormal epileptic discharges and video-polysomnography showed central hypersomnolence. The patient also had decreased hypocretin-1 concentration in the cerebrospinal fluid and an HLA DQB1*0602 allele. We reviewed the available literature to increase awareness of this rare comorbidity and discuss the treatment and possible coexistence mechanism of NT1 and epilepsy.

A 18-yr-old girl has exhibited more severe daytime sleepiness with 10 years history of narcolepsy.  She became obese quickly after disease onset. Polysomnography demonstrated increased apnea-hypopnea index (AHI) of 3.0, but rapid-eye-movement sleep-predominant central sleep apnea index up to 15.3. Multiple sleep latency tests (MSLT) showed shortened mean sleep latency and five sleep-onset REM period (SOREMP). She was diagnosed with central sleep apnea (CSA) and underwent appropriate positive airway pressure (PAP) . Our patient remains stable and has reported significant benefit from PAP usage. We offer possible neuro-physiological mechanisms herein that could explain the unique findings of this case. 

Unable to lie down

The patient, a 27-year-old male, was hospitalized due to paroxysm chest and abdominal convulsions and unable to lie down for 1 month.  Previous history of hypertension.  Neuropsychological assessment except depression and anxiety. No abnormalities were seen in the head, neck, chest and waist MRI.  Normal EEG, VPSG: Recurrent clonic-clonic twitches in awake supine position, reduced after sleep, relieved in awake sitting position.  A diagnosis of spinal myoclonus propria was made.  Treatment with clonazepam, diazepam and Zonisamide showed no improvement. Discuss the etiology and treatment

A Case Report of Anti-mGluR5 Autoimmune Encephalitis

Yan Chen1, Yanmei Zhu, Jia He, Jiaolin Zheng, Youyang Qu, Haiyan Gou, Yulan Zhu*

Epilepsy and Sleep Disorders Center of the Second Affiliated Hospital of Harbin University

Abstract

Associations between sleep disorders and autoimmune encephalitis have been noted increasingly in recent years. Here we first report a case of acute REM sleep behavior disorder (RBD) accompanied by cognitive impairment which was confirmed as anti-mGluR5 autoimmune encephalitis, in which the CSF anti-mGluR5 IgG was 1:100. The patient’s condition was improved significantly after being treated with methylprednisolone. No recurrence occurred after 6 months of follow-up. It can be concluded that the possibility of autoimmune encephalitis should be considered for acute or subacute sleep disorder with cognitive impairment and the cerebrospinal fluid autoimmune encephalitis antibody should be detected as soon as possible. Additionally, an active immune treatment would help improve prognosis significantly.

A 66-year-old man, a farmer by profession, was referred to us with a history of recurring disturbance of consciousness for the past one year. The attacks started with a loss of consciousness while working，eatting or watching TV, lasted from more than ten minutes to several hours. VEEG showed paroxysmal period more β waves，without epileptic waves. Antiepileptic treatment was ineffective, but he could wake up quickly after Flumazenil intravenous injection.

A 16-year-old female was admitted to hospital due to excessive daytime sleepiness for more than 20 days and was diagnosed for acute disseminated encephalomyelitis. Cranial magnetic resonance imaging (MRI) demonstrated abnormal signal intensity in hypothalamus. Autoimmune encephalitis antibodies and demyelinating antibodies were negative. Multiple sleep latency test results demonstrated an average sleep latency of 2 min and 3 SOREM periods in 4 naps. The CSF hypocretin level was 66.69 pg/ml. She was negative for human leukocyte antigens DQB1*0601(0601,0202). After treatment with steroids and IVIG, the patient’s  hypersomnia significantly improved. According to the literature review, inherited disorders, brain tumors , and head trauma are the three most frequent causes for symptomatic narcolepsy, and ADEM is rare. Most of the Site of onset are in the hypothalamus, and CSF orexin is usually a mild to moderate decline, with some normal levels.

Narcolepsy is a sleep disorder that still not fully recognized by clinicians, and many patients are often misdiagnosed with epilepsy, syncope, or mental disorders. Here we present a 57 year-old-patient diagnosed with narcolepsy , who has typical sleep attacks and cataplexy and has been found short sleep latency and sleep-onset rapid eye movement episodes in Multiple sleep latency test. High-dose corticosteroid therapy have shown some beneficial effects on excessive daytime sleepiness or cataplexy in this patient. The association between narcolepsy and autoimmunity is aslo going to be  discussed in this presentation.

A 13-year-old female admitted to the hospital with the chief complaint of "repeated fainting for 1 month". She had repeated fainting about 1 month ago, and reported that she could hear other people's voices in a daze during the fainting period, and could blink her eyes in response, and woke up on her own for about half an hour to 2 hours. There was no obvious improvement after anti-epileptic and anti-depressive treatment. Neurological examination showed no obvious positive signs. What disease is the patient considering?