REM sleep behavior disorder in Parkinson’s disease Muntean, Maria-Lucia; Sixel-Döring, Friederike; Trenkwalder, Claudia
Journal of Neural Transmission,
08/2014, Letnik:
121, Številka:
Suppl 1
Journal Article
Recenzirano
Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disorder characterized by loss of normal muscle atonia during REM sleep with recurrent dream enactment and excessive motor activity. ...It is a frequent feature in patients with Parkinson’s disease (PD) and other alpha-synucleinopathies, and can occur at any stage of the disease. RBD could be considered a premotor clinical manifestation, and can antedate by many years the motor symptomatology. The prognostic value of RBD for the risk of developing PD still needs to be established. This review article focuses on the clinical aspects, screening and diagnostic criteria as well as therapeutic aspects of RBD in PD patients. Pathophysiological pathways are also briefly reviewed.
REM Sleep Behavioral Events and Dreaming Muntean, Maria-Lucia; Trenkwalder, Claudia; Walters, Arthur S ...
Journal of clinical sleep medicine,
05/2015, Letnik:
11, Številka:
5
Journal Article
Odprti dostop
To clarify whether motor behaviors and/ or vocalizations during REM sleep, which do not yet fulfill diagnostic criteria for REM sleep behavior disorder (RBD) and were defined as REM sleep behavioral ...events (RBEs), correspond to dream enactments.
13 subjects (10 patients with Parkinson disease PD and 3 healthy controls) originally identified with RBE in a prospective study (DeNoPa cohort) were reinvestigated 2 years later with 2 nights of video-supported polysomnography (vPSG). The first night was used for sleep parameter analysis. During the 2nd night, subjects were awakened and questioned for dream recall and dream content when purposeful motor behaviors and/or vocalizations became evident during REM sleep. REM sleep without atonia (RWA) was analyzed on chin EMG and the cutoff set at 18.2% as specific for RBD.
At the time of this investigation 9 of 13 subjects with previous RBE were identified with RBD based upon clinical and EMG criteria. All recalled vivid dreams, and 7 subjects were able to describe dream content in detail. Four of 13 subjects with RBE showed RWA values below cutoff values for RBD. Three of these 4 subjects recalled having non-threatening dreams, and 2 (of these 3) were able to describe these dreams in detail.
RBE with RWA below the RBD defining criteria correlate to dreaming in this selected cohort. There is evidence that RBEs are a precursor to RBD.
Parkinson's disease (PD) is one of the most common neurodegenerative diseases, and PD patients can present a variety of comorbidities that increase with age. Among them, cardiovascular and ...cerebrovascular diseases are the most prominent.
To assess the cardiovascular and cerebrovascular profiles of PD patients.
The cardiovascular risk factors of 126 PD patients were assessed according to laboratory tests (fasting blood sugar, serum cholesterol, triglycerides, and total lipids), Doppler ultrasound examinations and personal histories of cerebrovascular disease (ischemic/hemorrhagic), cardiovascular disease (myocardial infarct or angina confirmed by electrocardiogram), hypertension and diabetes. All patients underwent cerebral structural imaging procedures: computed tomography or magnetic resonance imaging.
58.73% of the patients presented with hypertension, with a slight predominance of female patients (65.38% vs 47.92%, P = 0.05). Carotid or vertebral atheromatosis was present in 39 (30.95%) and 28 (22.22%) of patients, respectively, and was statistically correlated with the presence of ischemic lesions on cerebral imaging. Regarding the computed tomography findings, 33 patients (28.21%) presented with cortical atrophy that was not correlated with any of the investigated cardiovascular factors.
Our findings indicate that risk factors for cardiovascular and cerebrovascular diseases are common in PD patients, possibly due to their older age. The presence of atherosclerosis and its complications can be detected in cerebral imaging studies.
Background
The frequency of RLS in Parkinson's disease (PD) patients has been reported to be between 10% and 26%. Several hypotheses have sought to link these two diseases; however, the ...pathophysiology of RLS in PD patients has yet to be completely defined. Many patients with idiopathic RLS have low serum ferritin levels, which negatively influence RLS symptomatology. Our objective was to investigate the role of iron deficiency in PD patients with and without RLS.
Methods
We consecutively included 42 PD inpatients undergoing pharmacological treatment. Patients with anemia, renal insufficiency, or polyneuropathy were excluded from the study. The control group consisted of 42 PD inpatients without RLS (PD‐nonRLS), matched for age and severity of PD. RLS was diagnosed clinically according to diagnostic criteria. Serum ferritin levels were measured at admission for all patients.
Results
Mean serum ferritin values were 142.20 ± 91.17 ng/dL for PD patients with RLS (PD+RLS) and 160.65 ± 142.57 ng/dL in PD‐nonRLS (P = 0.704). There was no difference concerning the total dopaminergic dose (levodopa equivalent dose) between PD+RLS and PD‐nonRLS patients (828.22 ± 389.02 vs. 775.32 ± 324.69 mg; P = 0.501). The frequency of dopamine agonist (DA) use did not differ between the two groups (P = 0.306).
Conclusions
There were no significant differences in serum ferritin levels between PD+RLS and PD‐nonRLS in our study. This suggests a different pathophysiology of RLS in PD patients, where iron deficiency is not necessarily observed. DA use was not found to be associated with the occurrence of RLS symptoms.
Summary
Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterised by an urge to move the limbs with a circadian pattern (occurring in the evening/at night), more prominent at ...rest, and relieved with movements. RLS is one of the most prevalent sleep disorders, occurring in 5%–10% of the European population. Thomas Willis first described RLS clinical cases already in the 17th century, and Karl‐Axel Ekbom described the disease as a modern clinical entity in the 20th century. Despite variable severity, RLS can markedly affect sleep (partly through the presence of periodic leg movements) and quality of life, with a relevant socio‐economic impact. Thus, its recognition and treatment are essential. However, screening methods present limitations and should be improved. Moreover, available RLS treatment options albeit providing sustained relief to many patients are limited in number. Additionally, the development of augmentation with dopamine agonists represents a major treatment problem. A better understanding of RLS pathomechanisms can bring to light novel treatment possibilities. With emerging new avenues of research in pharmacology, imaging, genetics, and animal models of RLS, this is an interesting and constantly growing field of research. This review will update the reader on the current state of RLS clinical practice and research, with a special focus on the contribution of European researchers.
Update on restless legs syndrome Bartl, Michael; Trenkwalder, Claudia; Muntean, Maria-Lucia ...
Nervenarzt
91, Številka:
10
Journal Article
Recenzirano
Restless legs syndrome (RLS), with a lifetime prevalence of up to 10%, is a frequent neurological disease and the most common movement disorder in sleep. A compulsive urge to move the legs with ...sensory symptoms and sleep disturbances can significantly impair the quality of life. Furthermore, RLS frequently occurs as a comorbidity to various internal and neurological diseases. It is diagnosed clinically based on the five essential diagnostic criteria. For treatment, an iron deficiency should first be excluded. Drugs approved for the treatment of RLS include dopaminergics (L-DOPA/benserazide) and dopamine agonists as well as oxycodone/naloxone, as a second-line treatment in severe cases. Augmentation as a deterioration of symptoms is a clinically defined complication of high-dose dopaminergic treatment, requiring special management strategies. Due to its high prevalence of up to 25%, RLS plays also an important role in the care of pregnant women.
Background. Patients with multiple system atrophy (MSA), similarly to patients with alpha-synucleinopathies, can present with different sleep problems. We sought to analyze sleep problems in the two ...subtypes of the disease MSA cerebellar type (MSA-C) and MSA parkinsonian type (MSA-P), paying special attention to REM sleep disturbances and periodic limb movements (PLMs). Methods. In the study we included 11 MSA-C and 27 MSA-P patients who underwent one night polysomnography. For the analysis, there were 37 valid polysomnographic studies. Results. Sleep efficiency was decreased in both groups (MSA-C, 64.27% ± 12.04%; MSA-P, 60.64% ± 6.01%). The PLM indices using standard measures, in sleep (PLMS) and while awake (PLMW), were high in both groups (MSA-C patients: PLMS index 72 ± 65, PLMW index 38 ± 33; MSA-P patients: PLMS index 66 ± 63, PLMW index 48 ± 37). Almost one-third of the MSA patients of both groups presented features of RLS on video-polysomnography. RBD was described in 8/11 (73%) patients with MSA-C and 19/25 (76%) patients with MSA-P (P=0.849). Conclusion. Our results showed very similar polysomnographic results for both MSA-P and MSA-C patients as a probable indicator for the similar pathologic mechanism of the disease and especially of its sleep problems.
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