Rhythmic movements and sleep paralysis in narcolepsy with cataplexy: A video-polygraphic study

Video 1, segment 1: split-screen video recording of two SP episodes in patient 1, occurring during the first (9 a.m. – left side) and the third (1 p.m. – right side) nap opportunities of the MSLT. The split-screen video recording emphasize the intraindividual stereotypy of the motor pattern. The patient was recumbent on the right side, and had rhythmic rotational hip movements, possibly associated with extension or flexion of the left leg. The movements were progressively more pronounced and frequent, and continued until the patient, finally, fell fully asleep. The rotational hip movements were consistent with a body rolling motor pattern. At awakening she reported that she presented SP associated with her commonly occurring hallucinatory tactile sensations of “little animals walking on her body, starting from the feet” in both episodes, “and reaching her neck” in the second episode, “inducing fear and disgust”. Video 1, segment 2: video recording of the SP in patient 2. The video recording showed that, while recumbent in supine position, the patient suddenly opened his eyes and repetitively moved his feet (hypnagogic foot tremor) for 10-15 seconds, showing either a tremor or an alternating activation of the legs, then after a few seconds he briefly moved his hands and after another 10 seconds he started shaking his feet until regaining the normal motor control. Afterwards the patient reported the hallucinatory, frightening, experience of “something” coming from under the bed, and that he voluntarily tried to wake up moving himself, succeeding only after a while. Video 1, segment 3: split-screen video-polysomnographic recording of the SP in patient 3, occurring at the onset of nocturnal sleep. The episode emerged after three minutes of nocturnal SOREMP; the polygraphic tracing during the motor phenomena (head shaking) displayed mixed characteristics of REM and wakefulness. In particular, the EEG showed a desynchronized alpha-theta activity, the chin EMG disclosed fluctuating muscle atonia with transient increases associated with the motor phenomena, whereas the EOG showed the occurrence of rapid eye movements. At the end of the motor phenomena the polysomnographyc tracing showed a normal REM sleep. Video 1, segment 4: video-polysomnographic recording of the SP episode in patient 3, occurring during the first (9 a.m.) nap opportunity of the MSLT. The motor episode emerged at the transition between relaxed wakefulness and SOREMP, and the polysomnography during the head rolling showed a desynchronized alpha-theta EEG activity partially obscured by movement artifacts, fluctuating muscle chin EMG atonia with repetitive bursts associated with the motor phenomena, and a mixture of rapid and slow eye movements. At the end of the motor phenomena, the polysomnography showed a REM sleep tracing.