You give the +* info, and it points right to Researchers who study "Sleep"...
specifically, those who study the waking-consciousness/sleeping-consciousness
transition, and those who study stuff like Sleep-Walking and Sleep-Talking.
During the waking-consciousness/sleeping-consciousness transition, the
musculature becomes relatively-inhibited... so folks don't have to deal with
effector-activation during REM-Sleep.
Your Patient's difficulties stem, certainly, from stuff that the above
Researchers have the best-"grasp" of. She has a deficit in either the
Neuroanatomy, or the Neurophysiology, which governs the
waking-consciousness/sleeping-consciousness transition. Seek out the above
folks, even if only through correspondence, and ask them, also, to refer you to
Neuropharmacologists that have a waking-consciousness/sleeping-consciousness
transition bent.
It might be that your Patient can serve the whole field that I've referred to,
above, because her symptoms are a relatively-well-refined subset of the overall
waking-consciousness/sleeping-consciousness transition problem. If that's the
case, the above Researchers might have keen interest, and that'd, possibly, be
a very-good thing for your Patient. ken collins
Richard Hall wrote:
> I recently made the acquaintance of a woman, age 44, who suffers prolonged
> episodes of painful fasciculations. Contractions begin in the calf and
> over a period of minutes irradiate up the leg causing intense tetanic
> contractions. The attacks are usually asymmetrical (usually the left side,
> sometimes the right, and occasionaly both). I observed one attack and the
> increasing frequency of contration of the gastrocnemius was palpable. The
> muscle groups involved seem to include the hamstrings and the tensor fascia
> lata and possibly the gluteus. The episode lasted for over 18 hours and in
> subsequence conversations over the past three weeks she reports several
> incidents lasting days. The attacks typically begin in the evening as she
> falls asleep. She is also very sensitive to light touch which makes her
> ill at ease, possibly nauseous, and may trigger attacks.
>> She is bright, trim, athletic, well muscled, and normally very active. Her
> left side was traumatized in a boating accident possibly twenty years ago.
> I am not clear on this but her mother was apparently abusive, possibly
> physically as early as age 6. About 18 years ago she joined AA after 14
> years of intense alcohol abuse. The attacks began about 8-10 years ago and
> have been at times unrelenting. She states that Valium (5 mg) alleviates
> the symptoms completely but sets off an addictive cycle that she
> desparately wishes to avoid. Consequently, she has been into massage,
> accupuncture, diet therapies, and nothing seems to work. I have suggested
> she return to the states for medical attention, but she has no insurance
> and chooses to live in the British Virgin Islands where a physician will
> prescribe muscle relaxants which help but do not provide total or reliable
> relief. The fatigue and pain seem not to have eroded her clarity of
> thought but she is emotionally all over the place. Most likely because she
> fears sleep and never knows when the next attack will occur.
>> It is my hope that some sound ideas on the pathogenesis of this condition
> will persuade her to seek qualified medical assistance.
>> rlh
>> Richard Hall
> Comparative Animal Physiologist
> Division of Sciences and Mathematics
> University of the Virgin Islands
> St. Thomas, USVI 00802
>> 809-693-1386
>rhall at uvi.edu