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Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Neurology
Satisfied Customers: 3104
Experience:  Experience of Neurology of over 4 years, well versed in EEG, NCS and EMG alongwith MRIs and CT scans
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Do humans who suffer spinal cord injury and paralysis

Customer Question

Do humans who suffer spinal cord injury and paralysis experience spastic, active movement of limbs during REM sleep as they are healing or have healed? I have been trying to research this and found a condition called parasomnia; does it apply in this circumstance? What is happening with the affected nerves during this process? Thank you.
Submitted: 5 months ago.
Category: Neurology
Expert:  Dr. Muneeb Ali replied 5 months ago.

Hi,

Well first off if a person is paralyzed permanently, then his or her limbs would not experience ANY movement even if he or she is suffering from parasomnias. Parasomnias are essentially abnormal behaviours which occur during REM sleep or other parts of the sleep cycle. These include sleepwalking, sleep eating disorders etc. Now in case of a paralyzed person the limbs would not experience any movements at all simply because the signal to get them to move would be not be transmitted to the muscles. Paralysis due to spinal cord injuries basically means that the signals from the brain to the muscles are being cut off at the level of the spinal cord. Since the signal cannot be transmitted further, there is no question of movement at all.

Now in case of a healed spinal cord or healing spinal cord, the case is different and movements of limbs CAN take place however classifying them as parasomnias would be difficult. Simple spastic movements or jerks in the limbs would be more like myoclonus than anything else. these are jerky movements which can occur at any time even during sleep. Usually in case of a reflex action, the nerves sense a trigger in the environment and send a signal to the brain which processes it and sends the relevant commands back down into the spinal cord which transmits it to the muscles (eg a hand jerking awway from a hot object). Now After a spinal cord injury, the normal flow of signals is disrupted, and the message does not reach the brain. Instead, the signals are sent back to the motor cells in the spinal cord and cause a reflex muscle spasm. This can result in a twitch, jerk or stiffening of the muscle. It is possible that the spastic movements which are occuring during sleep are the result of this common effect which can occur in a healing cord injury. Spasticity of this sort can be treated with various medications.

However these movements would not be classified as parasomnias. parasomnias are essentially abnormal behaviours as i already said before, simple movements which occur during sleep would not be classified as parasomnias. And also during REM sleep a persons voluntary muscles are usually paralyzed to keep them from acting out dreams, if there is movement during REM sleep, that can be classified as a REM sleep disorder. A sleep study would be the only way to know in which part of the sleep cycle these movements are occurring.

So in short, movements like these could be a consequence of spasticity which can occur after spinal cord injury or even periodic limb movement disorder in which there can be spastic jerky movement of the limbs which occurs before or after the REM sleep.

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