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Sleep abnormalities in patients with brain stem lesions

From the Department of Neurology, Indiana University School of Medicine, Indianapolis.

Seven patients with "locked-in" syndrome were studied by prolonged polygraphic recordings. Severe alterations in the sleep pattern were observed in five patients who had bilateral extensive pontine lesions resulting in tetraplegia, facial and pseudobulbar paralysis, and absence of conjugate horizontal gaze. Rapid eye movement (REM) sleep was entirely absent while non-rapid eye movement (NREM) sleep was absent, reduced, or altered. The remaining two patients, both of whom had relative sparing of horizontal gaze and apparently either no or minimal pontine tegmental involvement, showed both REM and NREM sleep with only a minimal alteration in the sleep pattern. The study suggests that, in human beings as in animals, pontine structures near the midline are essential for control of sleep states.

Dr. Markand's address is Department of Neurology, Indiana University School of Medicine, 1100 West Michigan Street, Indianapolis, IN 46202.

Presented in part at the twenty-seventh annual meeting of the American Academy of Neurology, Bal Harbour, Florida, May 1975.

This study was supported in part by PHS grant No. NS06793.

Received for publication August 22, 1975.

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