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Abstract
PURPOSE OF REVIEW Nonrapid eye movement (NREM) parasomnias are common sleep disorders that potentially have significant personal, social and forensic implications. They represent a unique opportunity in nature to explore the coexistence of sleep and wake-state in the human brain. RECENT FINDINGS Neuroimaging and electroencephalography have advanced our understanding of NREM-parasomnia pathophysiology, and the interplay between wakefulness and sleep. These disorders are increasingly viewed as resulting from an evolutionary process with a basis in uni-hemispheric brain activity in sleep seen in some animals, maintaining consciousness and ability to act against life-threatening situations. Although current classification of NREM parasomnia phenotypes distinguishes between disorders of arousal and other types of behaviours, evidence increasingly points to there being a significant overlap between the various phenotypes. Treatment practice appears more standardized nowadays based on larger case series, but randomized control trials are still needed. SUMMARY NREM-parasomnia is a very common disorder of uncertain pathogenesis but of known pathophysiology, the diagnosis of which remains primarily clinical.
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Lopez R, Rivier F, Chelly J, Dauvilliers Y. Impaired glycinergic transmission in hyperekplexia: a model of parasomnia overlap disorder. Ann Clin Transl Neurol 2019; 6:1900-1904. [PMID: 31392847 PMCID: PMC6764621 DOI: 10.1002/acn3.50866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 01/05/2023] Open
Abstract
We report sleep phenotypes and polysomnographic findings in two siblings with a novel homozygous variant of the GLRA1 gene causing hereditary hyperekplexia (HH). Both sisters had startles during wakefulness and sleep, sleep terrors, and one had symptoms of REM sleep behavior disorder (RBD). Frequent startles were found in NREM sleep associated with NREM parasomnias in deep sleep. In REM sleep, both had motor behaviors and increased phasic/tonic muscle activities confirming RBD. Clonazepam improved startles, motor behaviors, and muscle activities in REM sleep. Impaired glycinergic transmission in human HH could be involved in the pathophysiology of RBD and NREM parasomnias.
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Affiliation(s)
- Régis Lopez
- Département de Neurologie, Unité des Troubles du Sommeil, CHU Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - François Rivier
- Department of Pediatric Neurology, Neuromuscular Diseases Reference Center AOC, CHU Montpellier, France.,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Jamel Chelly
- Service de Diagnostic Génétique, Hôpital Civil de Strasbourg, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IGBMC, INSERM, CNRS, Université de Strasbourg, Strasbourg, France
| | - Yves Dauvilliers
- Département de Neurologie, Unité des Troubles du Sommeil, CHU Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
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Cornejo-Sanchez DM, Carrizosa-Moog J, Cabrera-Hemer D, Solarte-Mila R, Gomez-Castillo C, Thomas R, Leal SM, Cornejo-Ochoa W, Pineda-Trujillo N. Sleepwalking and Sleep Paralysis: Prevalence in Colombian Families With Genetic Generalized Epilepsy. J Child Neurol 2019; 34:491-498. [PMID: 31012364 DOI: 10.1177/0883073819842422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sleep deprivation commonly increases seizure frequency in patients with genetic generalized epilepsy, though it is unknown whether there is an increased prevalence of sleepwalking or sleep paralysis in genetic generalized epilepsy patients. Establishing this could provide insights into the bio-mechanisms or genetic architecture of both disorders. The aim of this study was to determine the prevalence of sleepwalking and sleep paralysis in a cohort of patients with genetic generalized epilepsy and their relatives in extended families. METHODS A structured interview based on International League Against Epilepsy (ILAE) and International Classification of Sleep Disorders (ICSD-3) criteria was applied to 67 index cases and their relatives to determine genetic generalized epilepsy subtypes and assess the occurrence of sleepwalking or sleep paralysis. Bivariate analysis was performed using chi-square and Fisher exact tests. RESULTS The prevalence of sleepwalking and sleep paralysis was 15.3% (95% confidence interval 12.1-18.9) and 11.7% (95% confidence interval 8.7-15.3), respectively. Unusually, no sleepwalkers were found among individuals displaying epilepsy with generalized tonic-clonic seizures. Approximately a quarter of the patients had either parasomnia or genetic generalized epilepsy. Over half the genetic generalized epilepsy families had at least 1 individual with sleepwalking, and more than 40% of the families had one individual with sleep paralysis. CONCLUSION The prevalence of sleepwalking or sleep paralysis is reported for individuals with genetic generalized epilepsy and their relatives. The co-existence of either parasomnia in the genetic generalized epilepsy patients and the co-aggregation within their families let suggest that shared heritability and pathophysiological mechanisms exist between these disorders. We hypothesize that sleepwalking/sleep paralysis and genetic generalized epilepsy could be variable expression of genes in shared pathways.
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Affiliation(s)
| | - Jaime Carrizosa-Moog
- 1 Grupo Mapeo Genético, Facultad de Medicina, Universidad de Antioquia, Medellin-Colombia
| | - Dagoberto Cabrera-Hemer
- 2 Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Rodrigo Solarte-Mila
- 2 Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Rhys Thomas
- 4 Institute of Neuroscience, Newcastle University, United Kingdom
| | - Suzanne M Leal
- 5 Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - William Cornejo-Ochoa
- 2 Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
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Zakharov AV, Poverennova IE, Kalinin VA, Khivintseva EV. Disorders of arousal: the mechanism of occurrence, neurophysiological features. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:50-55. [DOI: 10.17116/jnevro201911904250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Our understanding of non-rapid eye movement (NREM) parasomnias has improved considerably over the last two decades, with research that characterises and explores the causes of these disorders. However, our understanding is far from complete. The aim of this paper is to provide an updated review focusing on adult NREM parasomnias and highlighting new areas in NREM parasomnia research from the recent literature. We outline the prevalence, clinical characteristics, role of onset, pathophysiology, role of predisposing, priming and precipitating factors, diagnostic criteria, treatment options and medico-legal implications of adult NREM parasomnias.
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Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, Montplaisir J, Boeve B. REM sleep behaviour disorder. Nat Rev Dis Primers 2018; 4:19. [PMID: 30166532 DOI: 10.1038/s41572-018-0016-5] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia that is characterized by loss of muscle atonia during REM sleep (known as REM sleep without atonia, or RSWA) and abnormal behaviours occurring during REM sleep, often as dream enactments that can cause injury. RBD is categorized as either idiopathic RBD or symptomatic (also known as secondary) RBD; the latter is associated with antidepressant use or with neurological diseases, especially α-synucleinopathies (such as Parkinson disease, dementia with Lewy bodies and multiple system atrophy) but also narcolepsy type 1. A clinical history of dream enactment or complex motor behaviours together with the presence of muscle activity during REM sleep confirmed by video polysomnography are mandatory for a definite RBD diagnosis. Management involves clonazepam and/or melatonin and counselling and aims to suppress unpleasant dreams and behaviours and improve bedpartner quality of life. RSWA and RBD are now recognized as manifestations of an α-synucleinopathy; most older adults with idiopathic RBD will eventually develop an overt neurodegenerative syndrome. In the future, studies will likely evaluate neuroprotective therapies in patients with idiopathic RBD to prevent or delay α-synucleinopathy-related motor and cognitive decline.
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Affiliation(s)
- Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France. .,INSERM, U1061, Montpellier, France, Université Montpellier, Montpellier, France.
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Alex Iranzo
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Pierre-Herve Luppi
- UMR 5292 CNRS/U1028 INSERM, Center of Research in Neuroscience of Lyon (CRNL), SLEEP Team, Université Claude Bernard Lyon I, Faculté de Médecine RTH Laennec, Lyon, France
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Jacques Montplaisir
- Department of Psychiatry, Université de Montréal, Québec, Canada and Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada
| | - Bradley Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
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