Involuntary Movements During Sleep: Possible Causes and Concerns

Q: Involuntary Movements During Sleep: Possible Causes and Concerns

Hello： I would suggest starting the investigation with paraneoplastic syndrome caused by prostate cancer, especially in patients with more severe conditions. <br>Cancer often produces various autoimmune antibodies that may attack normal tissue cells in the body, leading to a rang

Involuntary movements during sleep?

Hello Doctor, my father was recently diagnosed with prostate cancer and was hospitalized.
During his hospital stay, he often experienced involuntary movements and shaking of his limbs while sleeping, occasionally talking in his sleep and waving his arms and legs, but he would wake up and it would stop.
Initially, we thought this was due to low calcium levels caused by treatment to reduce hypercalcemia from the tumor.
After returning home, he has been regularly supplementing with calcium and vitamin D, but the movements have not improved.
Recently, we also noticed that his hands tremble when holding objects.
Additionally, he has a history of hip issues and experiences pain due to bone metastasis, making it difficult to assess his gait for muscle strength problems.
We are now concerned about the possibility of Parkinson's disease or thyroid issues (as he is currently undergoing hormone therapy, and we are unsure of its effects).
I would appreciate your professional perspective on this matter.
Thank you.

Hao, 20~29 year old female. Ask Date: 2020/11/14

Dr. Hong Weibin reply Neurology

Hello: I would suggest starting the investigation with paraneoplastic syndrome caused by prostate cancer, especially in patients with more severe conditions.
Cancer often produces various autoimmune antibodies that may attack normal tissue cells in the body, leading to a range of symptoms.
Some of these may affect cerebellar function, resulting in movement disorders.
Consider self-funded tests for autoimmune antibodies, such as Anti-Hu, Anti-Yo, Anti-VGCC, and Anti-neuronal antibodies, among others.
If antibody production is confirmed, plasmapheresis or immunomodulatory therapy may provide some benefit.
Additionally, prostate cancer is often associated with Cushing syndrome, so testing serum cortisol levels may be warranted.
Finally, it may be worth discussing with a physician whether brain imaging is necessary to rule out the possibility of brain metastasis.
Reference: Nature Reviews Urology volume 7, pages 681–692 (2010) https://www.nature.com/articles/nrurol.2010.186 Hong Wei-bin

Reply Date: 2020/11/14

More Info

Involuntary movements during sleep, such as twitching, jerking, or even speaking, can be concerning, especially in the context of a serious health condition like prostate cancer. Your father's situation, where he experiences these movements while hospitalized and continues to do so at home, raises several important considerations.

Firstly, the involuntary movements you describe could be related to a variety of factors. One common cause is sleep disorders, such as Periodic Limb Movement Disorder (PLMD) or REM Sleep Behavior Disorder (RBD). In PLMD, individuals experience involuntary leg movements during sleep, which can disrupt their sleep cycle and lead to daytime fatigue. RBD, on the other hand, involves acting out dreams, which can include movements like kicking or punching, and it often occurs during the REM stage of sleep.

Given your father's recent diagnosis and treatment for prostate cancer, it is also essential to consider the effects of medications and hormonal treatments on his neurological function. Certain medications can lead to side effects that include tremors or involuntary movements. Additionally, hormonal therapies can affect mood and neurological health, potentially leading to symptoms that mimic or exacerbate existing conditions.

Another possibility is that the involuntary movements could be related to neurological conditions, such as Parkinson's disease. Parkinson's is characterized by tremors, rigidity, and bradykinesia (slowness of movement). The fact that your father is experiencing tremors while holding objects, along with his history of hip pain and mobility issues, raises the question of whether there is an underlying neurological disorder.
Thyroid dysfunction, particularly hyperthyroidism, can also lead to tremors and muscle weakness. Since your father is undergoing hormonal treatment, it would be prudent to monitor his thyroid levels, as imbalances can significantly affect muscle control and overall health.

Given these considerations, it is crucial to consult with a healthcare professional who specializes in sleep medicine or neurology. A thorough evaluation, including a detailed medical history, physical examination, and possibly sleep studies or neurological assessments, will help determine the underlying cause of these involuntary movements.
In the meantime, keeping a sleep diary could be beneficial. Documenting when the movements occur, their frequency, and any associated symptoms can provide valuable information for the healthcare provider. Additionally, ensuring a safe sleep environment is essential, especially if your father is experiencing movements that could lead to injury.

In summary, while involuntary movements during sleep can be benign, they can also indicate underlying health issues that require attention. Given your father's medical history and current symptoms, a comprehensive evaluation is warranted to rule out any serious conditions and to ensure appropriate management and treatment.

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