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    A number sign (#) is used with this entry because of evidence that torsion dystonia-1 (DYT1) is caused by heterozygous mutation in the TOR1A gene (605204), encoding the ATP-binding protein torsin-A, on chromosome 9q34. 'Dystonia' describes a neurologic condition characterized by involuntary, sustained muscle contractions affecting one or more sites of the body; 'torsion' refers to the twisting nature of body movements observed in dystonia. Dystonia has been classified as primary (dystonia as the sole or major symptom) or secondary (a symptom of another disorder), and by age of onset, muscle groups affected, and mode of inheritance (2404852]" pmid="2404852"Johnson et al. (1962) described an extensively affected French-Canadian family. Age of onset of affected family members ranged from 6 to 42 years and severity of the disease varied considerably, with early-onset cases being severely affected. Minor manifestations interpreted as 'formes frustes' were found in some family members. In a large North American family of non-Jewish ancestry, Brin et al. cheap acyclovir cream Conditions that can result in insomnia include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and drugs such as caffeine, nicotine, and alcohol. Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed sleep phase disorder can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours. It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep. Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a middle-of-the-night awakening. Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of depression.

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    Intravenous fentanyl is often used for anaesthesia and analgesia. During anaesthesia it is often used along with a hypnotic agent like propofol. It is also administered in combination with a benzodiazepine, such as midazolam, to produce sedation for procedures such as endoscopy, cardiac catheterization, and oral surgery, or in emergency rooms. Fentanyl is sometimes given intrathecally as part of spinal anaesthesia or epidurally for epidural anaesthesia and analgesia. Because of fentanyl's high lipid solubility, its effects are more localized than morphine, and some clinicians prefer to use morphine to get a wider spread of analgesia. Rate of absorption is dependent on a number of factors. Body temperature, skin type, amount of body fat, and placement of the patch can have major effects. Syndromes Brody's syndrome Complex repetitive discharges Contracture: Muscle Cramps Cramp-Fasciculation Dominant Electrically silent Familial Electrical activity: No clinical Δ Endplate Spikes Fasciculations Fibrillations Miniature endplate potential Minipolymyoclonus Muscle pain Muscle spasms Myoedema Amyotrophic Lateral Sclerosis Black widow spider Blepharospasm Complex repetitive discharges Crisponi syndrome Dystonia variants Fasciculations Firing patterns Geniospasm Hemifacial spasm Isaac's Syndrome Motor neuron disorders Motor neuropathies Myokymia Neuromyotonia Palmaris brevis spasm Polyneuropathy Spinal: Vascular; Compression Startle syndrome (Hyperekplexia) Strychnine Stiff-Person Syndrome Superior oblique myokymia Tetanus Tetany Tremor Whipple's Return to Neuromuscular home page Return to Ion Channel Disorders Return to Myopathy & NMJ Index References 1. Neuromuscular Disorders 1999;4-607, J Neurol Neurosurg Psychiatry 2010;5-126, Neuromuscular Disord 2011; Online Feb 4. Neurology 2000;31-1555, Movement Disord 2002;3-866 8. Neurology 1999;53-1459; Muscle Nerve 2001;0-344 10. Ann Neurol 2001;6-492, Neurology 2015; Online November 11. Muscle Nerve 2002; S11: S55S58, Brain 2002;187-1895 17. BMC Neurology, Neuromuscular Disorders 2002;7351 25. N Engl J Med 2007;387-2695, Curr Opin Neurol 2011;-68 36.

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