Relapsing-remitting autoimmune agrypnia

A woman affected by multiple cranial nerve palsy developed several episodes of total insomnia and respiratory crises resulting from central breathing depression associated with dysautonomic symptoms. Oligoclonal IgG bands wer e present in her cerebrospinal fluid, and immunohistochemistry showed incre ased binding of serum and cerebrospinal fluid on gamma -aminobutyric acid-e rgic, synapse-rich neuronal cells. Immunosuppressive treatment and plasma e xchange were followed by clinical improvement, with restoration of sleep ar chitecture and disappearance of respiratory crises, suggesting autoimmune p athogenesis of the syndrome.