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Insomnia Insomnia

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120 Plotkin<br />

Table 1 (continued)<br />

Lewy body dementia<br />

Progressive supranuclear palsy<br />

Multiple systems atrophy<br />

Huntington’s disease<br />

Fatal Familial <strong>Insomnia</strong><br />

Creutzfeldt-Jakob disease<br />

Neuropathy/radiculopathy<br />

Muscular dystrophy<br />

Inflammatory myopathy<br />

Myelopathy<br />

Amyotrophic lateral sclerosis<br />

Stroke<br />

Multiple sclerosis<br />

Antoparkinsonian medications<br />

Cholinergic agonists<br />

Interferon therapy<br />

Cerebral mass lesions<br />

Cerebral palsy<br />

Headache<br />

Head injury<br />

Encephalitis/meningitis (including Lyme disease and HIV)<br />

Epileptic syndromes<br />

and bladder dysfunction that contribute to secondary insomnia. Restriction of body<br />

movement by severe neuropathy or myelopathy can cause discomfort due to the<br />

development of soreness over bony prominences, pressure sores, or arthralgia due<br />

to malpositioned extremities. For this reason, insomnia becomes especially prominent<br />

with the symptomatic progression of amyotrophic lateral sclerosis, worsening<br />

as bulbar involvement becomes prevalent (65).<br />

Stroke can produce impaired sleep due to structural changes in the cerebrum<br />

(56,66), especially when ischemia has affected the thalamus, anterior hypothalamus,<br />

or the central pons (67). A stroke can also produce insomnia by way of its<br />

associated physical symptoms, such as movement restriction due to paresis, sensory<br />

disruption causing parasthesia/dysesthesia, or impaired pharyngeal function<br />

causing aspiration and obstructive breathing. Multiple sclerosis may cause insomnia<br />

as demyelinated plaques involve more of the cortical mantle or the diencephalon,<br />

and may also be aggravated by motor, sensory, or urological symptoms that<br />

increase with the progression of the disease. <strong>Insomnia</strong> has also been reported with<br />

various forms of interferon therapy (68). It has been seen with lesions involving the<br />

pituitary (69) and pineal gland (70). Cerebral palsy may significantly affect sleep

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