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Edlinger F, Böck M, Seidel S, Trimmel K. Loss of rapid eye movement atonia in rapid eye movement sleep behaviour disorder and narcolepsy. J Sleep Res 2024:e14322. [PMID: 39168479 DOI: 10.1111/jsr.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/30/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
A reduction of physiological muscle atonia during rapid eye movement sleep is characteristic in patients with rapid eye movement sleep behaviour disorder, however, it can also be found in narcolepsy patients. We evaluated rapid eye movement sleep associated electromyographic activity to set cut-off values of rapid eye movement sleep without atonia, differentiating rapid eye movement sleep behaviour disorder and narcolepsy patients from controls to enable more precise future diagnostic criteria for these disorders. We retrospectively analysed polysomnography recordings of 16 rapid eye movement sleep behaviour disorder patients, 15 narcolepsy patients, and 19 controls. The combination of phasic and tonic electromyographic activity was recorded in the mentalis and tibialis anterior muscles and analysed in 3 second miniepochs. The cut-off value for a diagnosis of rapid eye movement sleep behaviour disorder was 17.07% (100% sensitivity, 94.7% specificity, area under the curve 0.997). For the diagnosis of narcolepsy, we yielded a cut-off value of 8.4% (86.4% sensitivity, 68.4% specificity, area under the curve 0.850). Rapid eye movement sleep without atonia significantly (p = 0.046) increased in the second night half in rapid eye movement sleep behaviour disorder patients, while it remained moderately increased in the narcolepsy group. Polysomnographic evaluation proves significantly higher rates of rapid eye movement sleep without atonia in rapid eye movement sleep behaviour disorder than in narcolepsy patients, allowing differentiation from controls with high sensitivity and specificity. An increase throughout the night is characteristic for rapid eye movement sleep behaviour disorder, whereas a consistent elevation is typical in narcolepsy patients.
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Affiliation(s)
| | - Marion Böck
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karin Trimmel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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2
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Konofal E. From past to future: 50 years of pharmacological interventions to treat narcolepsy. Pharmacol Biochem Behav 2024; 241:173804. [PMID: 38852786 DOI: 10.1016/j.pbb.2024.173804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/29/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
The history of narcolepsy research began with the pioneering work of Jean-Baptiste-Édouard Gélineau in the late 19th century. In the 1880s, Gélineau introduced the term "narcolepsy" to describe a condition characterized by sudden and uncontrollable episodes of sleep. His clinical descriptions laid the foundation for our understanding of this complex disorder. Over the last half-century, the pharmacological landscape for narcolepsy treatment has evolved remarkably, shifting from merely managing symptoms to increasingly targeting its underlying pathophysiology. By the 1930s, treatments such as ephedrine and amphetamine were introduced to alleviate excessive daytime sleepiness, marking significant advancements in narcolepsy management. These stimulants provided temporary relief, helping patients maintain wakefulness during the day. As research progressed, the focus shifted towards understanding the disorder's underlying mechanisms. The discovery of orexin (also known as hypocretin) in the late 1990s revolutionized the field. This breakthrough underscored the importance of orexin in regulating sleep-wake cycles and provided new targets for pharmacological intervention. Looking ahead, the future of narcolepsy pharmacotherapy is poised for further innovation. The ongoing exploration of orexin receptor agonists and the potential development of neuroprotective therapeutic targets underscore a promising horizon. Emerging research into the genetic and immunological underpinnings of narcolepsy opens new avenues for personalized medicine approaches and the identification of biomarkers for more precise treatment strategies. Additionally, the refinement of existing treatments through improved delivery systems and the investigation of combination therapies offer opportunities for enhanced efficacy and improved quality of life for patients with narcolepsy.
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Affiliation(s)
- Eric Konofal
- Centre Pédiatrique des Pathologies du Sommeil, APHP Hôpital Robert Debré, 48 Boulevard Sérurier, Paris 75019, France.
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3
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Abad VC. Pharmacological options for narcolepsy: are they the way forward? Expert Rev Neurother 2023; 23:819-834. [PMID: 37585269 DOI: 10.1080/14737175.2023.2249234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Narcolepsy is an under-recognized, rare neurologic disorder of hypersomnolence that is associated with increased mortality and medical and psychiatric co-morbidities. Narcolepsy exerts a substantial economic burden on patients and society. There is currently no cure, and life-long symptomatic therapy is needed. Available drugs do not modify the disease course. AREAS COVERED This manuscript provides an overview of narcolepsy symptoms, diagnosis, pathophysiology, current pharmacotherapies, and emerging treatments. Gaps and unresolved issues in diagnosis and management of narcolepsy are discussed to answer whether pharmacological options are the way forward. EXPERT OPINION Diagnostic criteria for narcolepsy (ICSD-3) need revision and greater clarity. Improved recognition of cataplexy and other symptoms through educational outreach, new biomarkers, improved test scoring through artificial intelligence algorithms, and use of machine learning may facilitate earlier diagnosis and treatment. Pharmacological options need improved symptomatic therapy in addition to targeted therapies that address the loss of hypocretin signaling. Optimal narcolepsy care also needs a better understanding of the pathophysiology, recognition of the different phenotypes in narcolepsy, identification of at-risk individuals and early recognition of symptoms, better diagnostic tools, and a database for research and disease monitoring of treatment, side-effects, and comorbidities.
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Affiliation(s)
- Vivien C Abad
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences Stanford University, Redwood, CA, USA
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Fan FF, Vetrivelan R, Yang Y, Guo ZN, Lu J. Role of pontine sub-laterodorsal tegmental nucleus (SLD) in rapid eye movement (REM) sleep, cataplexy, and emotion. CNS Neurosci Ther 2023; 29:1192-1196. [PMID: 36585816 PMCID: PMC10018081 DOI: 10.1111/cns.14074] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023] Open
Abstract
Pontine sub-laterodorsal tegmental nucleus (SLD) is crucial for REM sleep. However, the necessary role of SLD for REM sleep, cataplexy that resembles REM sleep, and emotion memory by REM sleep has remained unclear. To address these questions, we focally ablated SLD neurons using adenoviral diphtheria-toxin (DTA) approach and found that SLD lesions completely eliminated REM sleep accompanied by wake increase, significantly reduced baseline cataplexy amounts by 40% and reward (sucrose) induced cataplexy amounts by 70% and altered cataplexy EEG Fast Fourier Transform (FFT) from REM sleep-like to wake-like in orexin null (OXKO) mice. We then used OXKO animals with absence of REM sleep and OXKO controls and examined elimination of REM sleep in anxiety and fear extinction. Our resulted showed that REM sleep elimination significantly increased anxiety-like behaviors in open field test (OFT), elevated plus maze test (EPM) and defensive aggression and impaired fear extinction. The data indicate that in OXKO mice the SLD is the sole generator for REM sleep; (2) the SLD selectively mediates REM sleep cataplexy (R-cataplexy) that merges with wake cataplexy (W-cataplexy); (3) REM sleep enhances positive emotion (sucrose induced cataplexy) response, reduces negative emotion state (anxiety), and promotes fear extinction.
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Affiliation(s)
- Fang-Fang Fan
- Stroke Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.,Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Ramalingam Vetrivelan
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Yi Yang
- Stroke Center, Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Stroke Center, Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Jun Lu
- Stroke Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.,Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
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New Paradigm in the Management of REM Sleep Behavior Disorder. CURRENT SLEEP MEDICINE REPORTS 2023. [DOI: 10.1007/s40675-023-00248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Zhang H, Zhang Y, Ren R, Yang L, Shi Y, Vitiello MV, Sanford LD, Tang X. Polysomnographic features of idiopathic restless legs syndrome: a systematic review and meta-analysis of 13 sleep parameters and 23 leg movement parameters. J Clin Sleep Med 2022; 18:2561-2575. [PMID: 35903949 PMCID: PMC9622979 DOI: 10.5664/jcsm.10160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES This study aims to explore the polysomnographically measured sleep and leg movement differences between idiopathic restless legs syndrome (RLS) patients and healthy controls. METHODS An electronic literature search was conducted in EMBASE, MEDLINE, all EBM databases, CINAHL, and PsycINFO. Only observational case-control studies were included in the meta-analysis. The differences in 13 sleep parameters and 23 leg movement parameters between RLS patients and healthy controls were explored. RESULTS Thirty-eight studies were identified for systematic review, 31 of which were used for meta-analysis. Meta-analyses revealed significant reductions in total sleep time, sleep efficiency, stage N2 and rapid eye movement (REM) sleep percentages, and increases in wake time after sleep onset, stage shifts per hour, stage N1 percentage, REM latency, arousal index, and apnea-hypopnea index. Some leg movement parameters, such as periodic limb movement during sleep (PLMS) index, PLMS sequence duration, number of PLMS sequence, and periodicity index, were higher in RLS patients compared with healthy controls. Further, our meta-analysis revealed a higher PLMS index during non-REM sleep compared with that during REM sleep. CONCLUSIONS RLS patients manifest a lightening of sleep, increased sleep fragmentation, and greater sleep-related breathing disruption and limb movements during sleep relative to healthy normal individuals. The distributions of PLMS during a night's sleep may provide more information to clarify the specific characteristics of leg movements in RLS. PLMS in RLS are concentrated in non-REM sleep. The periodicity index may be a more sensitive and specific marker of RLS than the PLMS index. CITATION Zhang H, Zhang Y, Ren R, et al. Polysomnographic features of idiopathic restless legs syndrome: a systematic review and meta-analysis of 13 sleep parameters and 23 leg movement parameters. J Clin Sleep Med. 2022;18(11):2561-2575.
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Affiliation(s)
- Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Larry D. Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, Virginia
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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The REM-sleep related characteristics of narcolepsy: A nation-wide multi-center study in Turkey, the REMCON study. Sleep Med 2022; 94:17-25. [DOI: 10.1016/j.sleep.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
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8
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Leu-Semenescu S, Maranci JB, Lopez R, Drouot X, Dodet P, Gales A, Groos E, Barateau L, Franco P, Lecendreux M, Dauvilliers Y, Arnulf I. Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias. J Clin Sleep Med 2022; 18:1355-1364. [PMID: 34984974 PMCID: PMC9059608 DOI: 10.5664/jcsm.9862] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the frequency, determinants and clinical impact of clinical NREM and REM parasomnias in adult patients with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH) compared to healthy controls. METHODS Familial and past and current personal parasomnias were assessed by questionnaire and medical interviews in 710 patients (220 NT1, 199 NT2, and 221 IH) and 595 healthy controls. RESULTS Except for sleep-related eating disorder (SRED), current NREM parasomnias were rare in all patient groups and controls. SRED was more frequent in NT1 patients (7.9%, vs. 1.8% in NT2 patients, 2.1% in IH patients and 1% in controls) and associated with disrupted nighttime sleep (odds ratio [OR] = 3.9) and nocturnal eating in full awareness (OR = 6.9) but not with sex. Clinical REM sleep behavior disorder (RBD) was more frequent in NT1 patients (41.4%, half being violent) than in NT2 patients (13.2%) and affected men more often than women (OR = 2.4). It was associated with disrupted nighttime sleep, depressive symptoms and antidepressant use. Frequent (>1/week) nightmares were reported by 39% of patients with NT1, 29% with NT2 and 27.8% with IH (vs. 8.3% in controls) and were associated with depressive symptoms in narcolepsy. No parasomnia (except sleep-related hallucinations) worsened daytime sleepiness. CONCLUSIONS In patients with central disorders of hypersomnolence, comorbid NREM parasomnias (except SRED) are rare and do not worsen sleepiness. In contrast, REM parasomnias are prevalent (especially in NT1) and associated with male sex, disrupted nighttime sleep, depressive symptoms and antidepressant use.
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Affiliation(s)
- Smaranda Leu-Semenescu
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Jean-Baptiste Maranci
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
| | - Regis Lopez
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Xavier Drouot
- Clinical Neurophysiology Department, La Miletrie University Hospital, Poitiers, France
| | - Pauline Dodet
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Ana Gales
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Elisabeth Groos
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Lucie Barateau
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Patricia Franco
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Unit, Mother-Children Hospital, Hospices Civils de Lyon, University Lyon1, France, Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Michel Lecendreux
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Center, Hospital Robert-Debré, AP-HP, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Isabelle Arnulf
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
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9
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Yon MI, Azman F, Yon ME, Tezer FI. Nocturnal Rapid Eye Movement Sleep Without Atonia can Be a Diagnostic Parameter in Differentiating Narcolepsy Type 1 From Type 2. J Clin Neurophysiol 2021; 38:237-241. [PMID: 32141986 DOI: 10.1097/wnp.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We aimed to compare rapid eye movement sleep without atonia (RSWA), tonic RSWA, and phasic RSWA indices during polysomnography as a potential biomarker between narcolepsy type 1 and type 2. METHODS Medical files, polysomnography, and multiple sleep latency tests of patients with narcolepsy were evaluated retrospectively. A total of three adolescents and 31 adult patients were included. We calculated the total number of rapid eye movement (REM) epochs with tonic and phasic activity in accordance with the American Academy of Sleep Medicine manual scoring rules, version 2.4. We defined tonic RSWA index as the ratio of total number of REM sleep stage epochs with only tonic activity to total REM sleep stage epochs, phasic RSWA index as the ratio of total number of REM sleep stage epochs with only phasic activity to total REM sleep stage epochs, and RSWA index as the ratio of total number of REM stage sleep epochs with RSWA to total REM sleep stage epochs on the polysomnography. RESULTS Clinically and polysomnographically diagnosed 25 patients with narcolepsy type 1 and 9 patients with narcolepsy type 2 were included. The median age of the subjects was 30 (10, 61) and 36 (18, 64), respectively. Eleven narcolepsy type 1 patients (44%) and 4 narcolepsy type 2 patients (44.44%) were women. The RSWA index of ≥ 3% yielded a sensitivity of 76% and specificity of 88.9% (AUC = 0.77 (0.09), 95% confidence interval = 0.58 to 0.97, p = 0.01), and the tonic RSWA index of ≥ 2.2% yielded a sensitivity of 72% and specificity of 77.8% (area under the curve = 0.74 (0.1), 95% confidence interval = 0.54-0.94, p = 0.03). CONCLUSIONS As an electrophysiological biomarker, RSWA and tonic RSWA indices can be sensitive and specific polysomnography parameters in distinguishing narcolepsy type 1 from narcolepsy type 2.
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Affiliation(s)
- Mehmet Ilker Yon
- Hacettepe University, School of Medicine, Department of Neurology, Ankara, Turkey . Dr. Yon is now with the Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey; and
| | - Filiz Azman
- Hacettepe University, School of Medicine, Department of Neurology, Ankara, Turkey . Dr. Yon is now with the Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey; and
| | - Merve Ecem Yon
- Ankara Yildirim Beyazit Diskapi Training and Research Hospital, Ankara, Turkey
| | - F Irsel Tezer
- Hacettepe University, School of Medicine, Department of Neurology, Ankara, Turkey . Dr. Yon is now with the Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey; and
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10
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Effect of TAAR1/5-HT 1A agonist SEP-363856 on REM sleep in humans. Transl Psychiatry 2021; 11:228. [PMID: 33879769 PMCID: PMC8058073 DOI: 10.1038/s41398-021-01331-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/02/2021] [Accepted: 03/23/2021] [Indexed: 02/05/2023] Open
Abstract
SEP-363856 is a trace amine-associated receptor 1 (TAAR1) and 5-hydroxytryptamine type 1A (5-HT1A) agonist, currently in Phase 3 clinical trials for the treatment of schizophrenia. Although SEP-363856 activates TAAR1 and 5-HT1A receptors in vitro, an accessible marker of time- and concentration-dependent effects of SEP-363856 in humans is lacking. In rodents, SEP-363856 has been shown to suppress rapid eye movement (REM) sleep. The aim of the current study was to translate the REM sleep effects to humans and determine pharmacokinetic/pharmacodynamic (PK/PD) relationships of SEP-363856 on a measure of brain activity. The effects of SEP-363856 were evaluated in a randomized, double-blind, placebo-controlled, 2-way crossover study of single oral doses (50 and 10 mg) on REM sleep in healthy male subjects (N = 12 at each dose level). Drug concentrations were sampled during sleep to interpolate individual subject's pharmacokinetic trajectories. SEP-363856 suppressed REM sleep parameters with very large effect sizes (>3) following single doses of 50 mg and plasma concentrations ≥100 ng/mL. Below that effective concentration, the 10 mg dose elicited much smaller effects, increasing only the latency to REM sleep (effect size = 1). The PK/PD relationships demonstrated that REM sleep probability increased as drug concentrations declined below 100 ng/mL over the course of the night. SEP-363856 was generally safe and well tolerated at both doses. The REM sleep-suppressing effects of SEP-363856 provide an accessible marker of brain activity, which can aid in dose selection and help elucidate its therapeutic potential in further clinical trials.
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11
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Matar E, McCarter SJ, St Louis EK, Lewis SJG. Current Concepts and Controversies in the Management of REM Sleep Behavior Disorder. Neurotherapeutics 2021; 18:107-123. [PMID: 33410105 PMCID: PMC8116413 DOI: 10.1007/s13311-020-00983-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2020] [Indexed: 11/28/2022] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment and the loss of muscle atonia during REM sleep, known as REM sleep without atonia (RSWA). RBD can result in significant injuries, prompting patients to seek medical attention. However, in others, it may present only as non-violent behaviors noted as an incidental finding during polysomnography (PSG). RBD typically occurs in the context of synuclein-based neurodegenerative disorders but can also be seen accompanying brain lesions and be exacerbated by medications, particularly antidepressants. There is also an increasing appreciation regarding isolated or idiopathic RBD (iRBD). Symptomatic treatment of RBD is a priority to prevent injurious complications, with usual choices being melatonin or clonazepam. The discovery that iRBD represents a prodromal stage of incurable synucleinopathies has galvanized the research community into delineating the pathophysiology of RBD and defining biomarkers of neurodegeneration that will facilitate future disease-modifying trials in iRBD. Despite many advances, there has been no progress in available symptomatic or neuroprotective therapies for RBD, with recent negative trials highlighting several challenges that need to be addressed to prepare for definitive therapeutic trials for patients with this disorder. These challenges relate to i) the diagnostic and screening strategies applied to RBD, ii) the limited evidence base for symptomatic therapies, (iii) the existence of possible subtypes of RBD, (iv) the relevance of triggering medications, (v) the absence of objective markers of severity, (vi) the optimal design of disease-modifying trials, and vii) the implications around disclosing the risk of future neurodegeneration in otherwise healthy individuals. Here, we review the current concepts in the therapeutics of RBD as it relates to the above challenges and identify pertinent research questions to be addressed by future work.
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Affiliation(s)
- E Matar
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Forefront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - S J McCarter
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - E K St Louis
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| | - S J G Lewis
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Forefront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia.
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12
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Baltzan M, Yao C, Rizzo D, Postuma R. Dream enactment behavior: review for the clinician. J Clin Sleep Med 2020; 16:1949-1969. [PMID: 32741444 PMCID: PMC8034224 DOI: 10.5664/jcsm.8734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
NONE Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motor-suppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.
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Affiliation(s)
- Marc Baltzan
- Faculty of Medicine, Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Centre Intégré Universitaire des Soins et Services Sociaux du Nord de L’île de Montréal, Montréal, Canada
- Mount Sinai Hospital, Centre Intégré Universitaire des Soins et Services Sociaux du Centre-ouest de L’île de Montréal, Montréal, Canada
- Institut de Médecine du Sommeil, Montréal, Canada
| | - Chun Yao
- Integrated Program in Neuroscience, McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | - Dorrie Rizzo
- Faculty of Medicine, Department of Family Medicine, McGill University, Montréal, Canada
- Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux de l’ouest de l’île, Montréal, Canada
| | - Ron Postuma
- Research Institute of McGill University Health Centre, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
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13
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Roguski A, Rayment D, Whone AL, Jones MW, Rolinski M. A Neurologist's Guide to REM Sleep Behavior Disorder. Front Neurol 2020; 11:610. [PMID: 32733361 PMCID: PMC7360679 DOI: 10.3389/fneur.2020.00610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
REM Sleep Behavior Disorder (RBD) is a chronic sleep condition characterized by dream enactment and loss of REM atonia. Individuals often present to clinic with complaints of injury to themselves or their bed-partner due to violent movements during sleep. RBD patients have a high risk of developing one of the neurodegenerative α-synucleinopathy diseases: over 70% will develop parkinsonism or dementia within 12 years of their diagnosis. RBD patients also exhibit accelerated disease progression and a more severe phenotype than α-synucleinopathy sufferers without RBD. The disease's low prevalence and the relatively limited awareness of the condition amongst medical professionals makes the diagnosis and treatment of RBD challenging. Uncertainty in patient management is further exacerbated by a lack of clinical guidelines for RBD patient care. There are no binary prognostic markers for RBD disease course and there are no clinical guidelines for neurodegeneration scaling or tracking in these patients. Both clinicians and patients are therefore forced to deal with uncertain outcomes. In this review, we summarize RBD pathology and differential diagnoses, diagnostic, and treatment guidelines as well as prognostic recommendations with a look to current research in the scientific field. We aim to raise awareness and develop a framework for best practice for RBD patient management.
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Affiliation(s)
- Amber Roguski
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Dane Rayment
- Rosa Burden Centre, Southmead Hospital, Bristol, United Kingdom
| | - Alan L Whone
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom.,Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Matt W Jones
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Michal Rolinski
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom.,Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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14
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Naeimi SA, Montplaisir JY, Gagnon JF, Postuma RB. Neurodegeneration in Narcolepsy-Associated Rapid Eye Movement Sleep Behavior Disorder. Mov Disord Clin Pract 2020; 7:208-210. [PMID: 32071942 DOI: 10.1002/mdc3.12895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/27/2019] [Accepted: 12/07/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seyed Ali Naeimi
- Department of Neurology Montreal General Hospital, McGill University Montreal Quebec Canada
| | - Jacques Y Montplaisir
- Centre for Advanced Research in Sleep Medicine Hopital du Sacre-Cœur de Montreal Montreal Quebec Canada.,Department of Psychiatry Université de Montréal Montreal Quebec Canada
| | - Jean-Francois Gagnon
- Centre for Advanced Research in Sleep Medicine Hopital du Sacre-Cœur de Montreal Montreal Quebec Canada.,Department of Psychology Université du Québec à Montréal Montreal Quebec Canada
| | - Ronald B Postuma
- Department of Neurology Montreal General Hospital, McGill University Montreal Quebec Canada.,Centre for Advanced Research in Sleep Medicine Hopital du Sacre-Cœur de Montreal Montreal Quebec Canada
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15
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Hershner S, Dauvilliers Y, Chung F, Singh M, Wong J, Gali B, Kakkar R, Mignot E, Thorpy M, Auckley D. Knowledge Gaps in the Perioperative Management of Adults With Narcolepsy: A Call for Further Research. Anesth Analg 2020; 129:204-211. [PMID: 30882519 DOI: 10.1213/ane.0000000000004088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There is increasing awareness that sleep disorders may be associated with increased perioperative risk. The Society of Anesthesia and Sleep Medicine created the Narcolepsy Perioperative Task Force: (1) to investigate the current state of knowledge of the perioperative risk for patients with narcolepsy, (2) to determine the viability of developing perioperative guidelines for the management of patients with narcolepsy, and (3) to delineate future research goals and clinically relevant outcomes. The Narcolepsy Perioperative Task Force established that there is evidence for increased perioperative risk in patients with narcolepsy; however, this evidence is sparse and based on case reviews, case series, and retrospective reviews. Mechanistically, there are a number of potential mechanisms by which patients with narcolepsy could be at increased risk for perioperative complications. These include aggravation of the disease itself, dysautonomia, narcolepsy-related medications, anesthesia interactions, and withdrawal of narcolepsy-related medications. At this time, there is inadequate research to develop an expert consensus or guidelines for the perioperative management of patients with narcolepsy. The paucity of available literature highlights the critical need to determine if patients with narcolepsy are at an increased perioperative risk and to establish appropriate research protocols and clearly delineated patient-centered outcomes. There is a real need for collaborative research among sleep medicine specialists, surgeons, anesthesiologists, and perioperative providers. This future research will become the foundation for the development of guidelines, or at a minimum, a better understanding how to optimize the perioperative care of patients with narcolepsy.
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Affiliation(s)
- Shelley Hershner
- From the Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Yves Dauvilliers
- Neurology and Physiology, Department of Neurology, Gui-de-Chauliac Hospital, Montpellier, France
| | - Frances Chung
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mandeep Singh
- Department of Anesthesia and Pain Management, Women's College Hospital and Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Toronto Sleep and Pulmonary Centre, Toronto, Canada
| | - Jean Wong
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bhargavi Gali
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rahul Kakkar
- Narcolepsy Network Inc, Lynnwood, WA.,Prana Health, Doral, Florida
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - Michael Thorpy
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio
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16
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REM sleep behavior disorder in narcolepsy: A secondary form or an intrinsic feature? Sleep Med Rev 2019; 50:101254. [PMID: 31931470 DOI: 10.1016/j.smrv.2019.101254] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 01/17/2023]
Abstract
Disrupted nighttime sleep is one of the pentad of symptoms defining Narcolepsy. REM sleep behavior disorder (RBD) largely contributes to night sleep disruption and narcolepsy is the most common cause of secondary RBD. However, RBD linked to narcolepsy (N-RBD) has been insufficiently characterized, leaving unsolved a number of issues. Indeed, it is still debated whether N-RBD is an intrinsic feature of narcolepsy, as indubitable for cataplexy, and therefore strictly linked to the cerebrospinal fluid hypocretin-1 (CSF hcrt-1) deficiency, or an associated feature, with a still unclear pathophysiology. The current review aims at rendering a comprehensive state-of-the-art of N-RBD, highlighting the open and unsettled topics. RBD reportedly affects 30-60% of patients with Narcolepsy type 1 (NT1), but it may be seen also in Narcolepsy type 2 (NT2). When compared to idiopathic/isolated RBD (iRBD), N-RBD has been reported to be characterized by less energetic and quieter episode, which however occur with the same probability in the first and the second part of the night and sometime even subcontinuously. N-RBD patients are generally younger than those with iRBD. N-RBD has been putatively linked to wake-sleep instability due to CSF hcrt-1 deficiency, but this latter by itself cannot explain completely the phenomenon as N-RBD has not been universally linked to low CSF hcrt-1 levels and it may be observed also in NT2. Therefore, other factors may probably play a role and further studies are needed to clarify this issue. In addition, therapeutic options have been poorly investigated.
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17
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Dijkstra F, Van den Bossche K, de Bruyn B, Reyn N, Viaene M, De Volder I, Cras P, Crosiers D. REM sleep without atonia and the relation with Lewy body disease. Parkinsonism Relat Disord 2019; 67:90-98. [DOI: 10.1016/j.parkreldis.2019.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/13/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022]
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18
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Narcolepsy — clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol 2019; 15:519-539. [DOI: 10.1038/s41582-019-0226-9] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
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19
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Sleep disorders in NiemannPick disease type C, beyond cataplexy. Sleep Med 2019; 57:122-127. [PMID: 30974338 DOI: 10.1016/j.sleep.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to clinically characterize sleep disorders in a cohort of Niemann-Pick type C (NPC) patients, correlating these findings with disease features and polysomnographic (PSG) results. METHODS We evaluated eight consecutive patients with molecular confirmation of NPC followed at the Hospital Geral de Fortaleza. Patients underwent a comprehensive neurological and sleep evaluation. Four participants underwent polysomnography and then performed the multiple sleep latency test. RESULTS All eight patients evaluated had sleep disorders. Four participants performed polysomnography followed by multiple sleep latency test. Chronic insomnia and Obstructive Sleep Apnea (OSA) were the most frequent sleep disorders (62,5%). Two patients were diagnosed with Restless Legs Syndrome (RLS) (25%) and two with probable REM sleep behavior disorder (RBD) (25%). All the patients who did polysomnography had reduced and/or disorganized sleep, with reduction on sleep efficiency, total sleep time and REM sleep time. CONCLUSION Our results suggest that sleep abnormalities in Niemann-Pick type C patients may be more prevalent than previously thought.
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20
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Conditions associated with REM sleep behaviour disorder: description of a hospital series. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Abstract
Self-injurious behavior (SIB) has frequently been associated with psychiatric illness and neurological lesions as means of reducing tension or diverting from pain. However, these explanations did not capture the complexity of SIB in the case of Mr. X, a 62-year-old patient who ingested his fingers in his sleep where cognitive testing was valuable in informing diagnosis. Mr. X's SIB was severe enough that he had chewed beyond the middle phalanx for most of his fingers. Clinical symptoms included daytime sleepiness, hypnogogic hallucinations, and bradykinesia. His cognitive profile revealed declines in his intellectual functioning as well as visuospatial and executive deficits in the context of preserved attention, language, and memory. His cognitive and clinical presentation suggested that Mr. X had a neurodegenerative disorder, which may have contributed to his SIB. We believed that the most probable diagnosis may have been rapid eye movement behavioral sleep disorder in the context of Lewy bodies dementia.
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22
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Abstract
PURPOSE OF REVIEW This article outlines the fundamental brain mechanisms that control sleep-wake patterns and reviews how pathologic changes in these control mechanisms contribute to common sleep disorders. RECENT FINDINGS Discrete but interconnected clusters of cells located within the brainstem and hypothalamus comprise the circuits that generate wakefulness, non-rapid eye movement (non-REM) sleep, and REM sleep. These clusters of cells use specific neurotransmitters, or collections of neurotransmitters, to inhibit or excite their respective sleep- and wake-promoting target sites. These excitatory and inhibitory connections modulate not only the presence of wakefulness or sleep, but also the levels of arousal within those states, including the depth of sleep, degree of vigilance, and motor activity. Dysfunction or degeneration of wake- and sleep-promoting circuits is associated with narcolepsy, REM sleep behavior disorder, and age-related sleep disturbances. SUMMARY Research has made significant headway in identifying the brain circuits that control wakefulness, non-REM, and REM sleep and has led to a deeper understanding of common sleep disorders and disturbances.
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23
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Barone DA, Henchcliffe C. Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clin Neurophysiol 2018; 129:1551-1564. [PMID: 29883833 DOI: 10.1016/j.clinph.2018.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) involves REM sleep without atonia in conjunction with a recurrent nocturnal dream enactment behavior, with vocalizations such as shouting and screaming, and motor behaviors such as punching and kicking. Secondary RBD is well described in association with neurological disorders including Parkinson's disease (PD), multiple system atrophy (MSA), and other conditions involving brainstem structures such as tumors. However, RBD alone is now considered to be a potential harbinger of later development of neurodegenerative disorders, in particular PD, MSA, dementia with Lewy bodies (DLB), and pure autonomic failure. These conditions are linked by their underpinning pathology of alpha-synuclein protein aggregation. In RBD, it is therefore important to recognize the potential risk for later development of an alpha-synucleinopathy, and to investigate for other potential causes such as medications. Other signs and symptoms have been described in RBD, such as orthostatic hypotension, or depression. While it is important to recognize these features to improve patient management, they may ultimately provide clinical clues that will lead to risk stratification for phenoconversion. A critical need is to improve our ability to counsel patients, particularly with regard to prognosis. The ability to identify who, of those with RBD, is at high risk for later neurodegenerative disorders will be paramount, and would in addition advance our understanding of the prodromal stages of the alpha-synucleinopathies. Moreover, recognition of at-risk individuals for neurodegenerative disorders may ultimately provide a platform for the testing of possible neuroprotective agents for these neurodegenerative disorders.
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24
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St Louis EK, Boeve AR, Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord 2018; 32:645-658. [PMID: 28513079 DOI: 10.1002/mds.27018] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/15/2022] Open
Abstract
Rapid eye movement sleep behavior disorder is characterized by dream enactment and complex motor behaviors during rapid eye movement sleep and rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia) during polysomnography. Rapid eye movement sleep behavior disorder may be idiopathic or symptomatic and in both settings is highly associated with synucleinopathy neurodegeneration, especially Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. Rapid eye movement sleep behavior disorder frequently manifests years to decades prior to overt motor, cognitive, or autonomic impairments as the presenting manifestation of synucleinopathy, along with other subtler prodromal "soft" signs of hyposmia, constipation, and orthostatic hypotension. Between 35% and 91.9% of patients initially diagnosed with idiopathic rapid eye movement sleep behavior disorder at a sleep center later develop a defined neurodegenerative disease. Less is known about the long-term prognosis of community-dwelling younger patients, especially women, and rapid eye movement sleep behavior disorder associated with antidepressant medications. Patients with rapid eye movement sleep behavior disorder are frequently prone to sleep-related injuries and should be treated to prevent injury with either melatonin 3-12 mg or clonazepam 0.5-2.0 mg to limit injury potential. Further evidence-based studies about rapid eye movement sleep behavior disorder are greatly needed, both to enable accurate prognostic prediction of end synucleinopathy phenotypes for individual patients and to support the application of symptomatic and neuroprotective therapies. Rapid eye movement sleep behavior disorder as a prodromal synucleinopathy represents a defined time point at which neuroprotective therapies could potentially be applied for the prevention of Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Erik K St Louis
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Angelica R Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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25
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Pérez-Carbonell L, Leschziner G. Clinical update on central hypersomnias. J Thorac Dis 2018; 10:S112-S123. [PMID: 29445535 PMCID: PMC5803059 DOI: 10.21037/jtd.2017.10.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/05/2017] [Indexed: 12/28/2022]
Abstract
The central hypersomnias encompass a range of conditions causing persisting or intermittent excessive daytime sleepiness (EDS). These conditions therefore present not infrequently in general clinical sleep practice, and remain in the differential for patients presenting with sleepiness. Our understanding of the pathophysiology, diagnosis and management of these conditions has progressed significantly over recent years, and in this article we review this group of disorders, focussing in particular on recent changes in classification and diagnosis, pathophysiological advances, and novel treatment options.
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Affiliation(s)
- Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
| | - Guy Leschziner
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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26
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27
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Butcher NJ, Marras C, Pondal M, Rusjan P, Boot E, Christopher L, Repetto GM, Fritsch R, Chow EWC, Masellis M, Strafella AP, Lang AE, Bassett AS. Neuroimaging and clinical features in adults with a 22q11.2 deletion at risk of Parkinson's disease. Brain 2017; 140:1371-1383. [PMID: 28369257 DOI: 10.1093/brain/awx053] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/23/2017] [Indexed: 11/14/2022] Open
Abstract
The recurrent 22q11.2 deletion is a genetic risk factor for early-onset Parkinson's disease. Adults with the associated 22q11.2 deletion syndrome (22q11.2DS) may exhibit phenotypes that could help identify those at highest risk and reveal disease trajectories. We investigated clinical and neuroimaging features relevant to Parkinson's disease in 26 adults: 13 with 22q11.2DS at genetic risk of Parkinson's disease (mean age = 41.5 years, standard deviation = 9.7), 12 healthy age and sex-matched controls, and a 22q11.2DS patient with l-DOPA-responsive early-onset Parkinson's disease. Neuroimaging included transcranial sonography and positron emission tomography using 11C-dihydrotetrabenazine (11C-DTBZ), a radioligand that binds to the presynaptic vesicular monoamine transporter. The 22q11.2DS group without Parkinson's disease demonstrated significant motor and olfactory deficits relative to controls. Eight (61.5%) were clinically classified with parkinsonism. Transcranial sonography showed a significantly larger mean area of substantia nigra echogenicity in the 22q11.2DS risk group compared with controls (P = 0.03). The 22q11.2DS patient with Parkinson's disease showed the expected pattern of severely reduced striatal 11C-DTBZ binding. The 22q11.2DS group without Parkinson's disease however showed significantly elevated striatal 11C-DTBZ binding relative to controls (∼33%; P < 0.01). Results were similar within the 22q11.2DS group for those with (n = 7) and without (n = 6) psychotic illness. These findings suggest that manifestations of parkinsonism and/or evolution to Parkinson's disease in this genetic at-risk population may include a hyperdopaminergic mechanism. Adequately powered longitudinal studies and animal models are needed to evaluate the relevance of the observed clinical and imaging phenotypes to Parkinson's disease and other disorders that are more prevalent in 22q11.2DS, such as schizophrenia.
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Affiliation(s)
- Nancy J Butcher
- Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and the Edmond J. Safra Program in Parkinson's Disease Research, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margarita Pondal
- Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and the Edmond J. Safra Program in Parkinson's Disease Research, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Rusjan
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erik Boot
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, and Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Leigh Christopher
- Institute of Medical Science, University of Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and the Edmond J. Safra Program in Parkinson's Disease Research, University of Toronto, Toronto, Ontario, Canada.,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Research Institute, University Hospital Network, University of Toronto, Toronto, Ontario, Canada
| | - Gabriela M Repetto
- Centre for Genetics and Genomics, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Rosemarie Fritsch
- Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Recoleta, Universidad de Chile, Santiago, Chile
| | - Eva W C Chow
- Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Sunnybrook Health Sciences Research Centre, Toronto, Ontario, Canada
| | - Antonio P Strafella
- Institute of Medical Science, University of Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and the Edmond J. Safra Program in Parkinson's Disease Research, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Research Institute, University Hospital Network, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony E Lang
- Institute of Medical Science, University of Toronto, Ontario, Canada.,Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and the Edmond J. Safra Program in Parkinson's Disease Research, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, and Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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28
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Rodriguez CL, Jaimchariyatam N, Budur K. Rapid Eye Movement Sleep Behavior Disorder. Chest 2017; 152:650-662. [DOI: 10.1016/j.chest.2017.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 02/14/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022] Open
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29
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Antelmi E, Pizza F, Vandi S, Neccia G, Ferri R, Bruni O, Filardi M, Cantalupo G, Liguori R, Plazzi G. The spectrum of REM sleep-related episodes in children with type 1 narcolepsy. Brain 2017; 140:1669-1679. [PMID: 28472332 DOI: 10.1093/brain/awx096] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/26/2017] [Indexed: 11/14/2022] Open
Abstract
Type 1 narcolepsy is a central hypersomnia due to the loss of hypocretin-producing neurons and characterized by cataplexy, excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations and disturbed nocturnal sleep. In children, close to the disease onset, type 1 narcolepsy has peculiar clinical features with severe cataplexy and a complex admixture of movement disorders occurring while awake. Motor dyscontrol during sleep has never been systematically investigated. Suspecting that abnormal motor control might affect also sleep, we systematically analysed motor events recorded by means of video polysomnography in 40 children with type 1 narcolepsy (20 females; mean age 11.8 ± 2.6 years) and compared these data with those recorded in 22 age- and sex-matched healthy controls. Motor events were classified as elementary movements, if brief and non-purposeful and complex behaviours, if simulating purposeful behaviours. Complex behaviours occurring during REM sleep were further classified as 'classically-defined' and 'pantomime-like' REM sleep behaviour disorder episodes, based on their duration and on their pattern (i.e. brief and vivid-energetic in the first case, longer and with subcontinuous gesturing mimicking daily life activity in the second case). Elementary movements emerging either from non-REM or REM sleep were present in both groups, even if those emerging from REM sleep were more numerous in the group of patients. Conversely, complex behaviours could be detected only in children with type 1 narcolepsy and were observed in 13 patients, with six having 'classically-defined' REM sleep behaviour disorder episodes and seven having 'pantomime-like' REM sleep behaviour disorder episodes. Complex behaviours during REM sleep tended to recur in a stereotyped fashion for several times during the night, up to be almost continuous. Patients displaying a more severe motor dyscontrol during REM sleep had also more severe motor disorder during daytime (i.e. status cataplecticus) and more complaints of disrupted nocturnal sleep and of excessive daytime sleepiness. The neurophysiological hallmark of this severe motor dyscontrol during REM sleep was a decreased atonia index. The present study reports for the first time the occurrence of a severe and peculiar motor disorder during REM sleep in paediatric type 1 narcolepsy and confirms the presence of a severe motor dyscontrol in these patients, emerging not only from wakefulness (i.e. status cataplecticus), but also from sleep (i.e. complex behaviours during REM sleep). This is probably related to the acute imbalance of the hypocretinergic system, which physiologically acts by promoting movements during wakefulness and suppressing them during sleep.
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Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCSS, Institute of Neurological Sciences, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCSS, Institute of Neurological Sciences, Bologna, Italy
| | - Stefano Vandi
- IRCSS, Institute of Neurological Sciences, Bologna, Italy
| | - Giulia Neccia
- IRCSS, Institute of Neurological Sciences, Bologna, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology, I.C., Oasi Institute (IRCCS), Troina, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, University of Rome La Sapienza, Rome, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCSS, Institute of Neurological Sciences, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCSS, Institute of Neurological Sciences, Bologna, Italy
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Abenza Abildúa MJ, Miralles Martinez A, Arpa Gutiérrez FJ, Lores Gutiérrez V, Algarra Lucas C, Jimeno Montero C, Sánchez García B, Mata Álvarez-Santullano M, Borrue Fernández C, Cordero Martín G, Gutiérrez Cueto G, Torrecillas Narváez MD, Thuissard Vasallo I, Gómez Aceña A. Conditions associated with REM sleep behaviour disorder: Description of a hospital series. Neurologia 2017; 34:159-164. [PMID: 28215911 DOI: 10.1016/j.nrl.2016.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION REM sleep behaviour disorder (RBD) is characterised by violent behaviours (screaming, kicking, vivid dreams) during REM sleep. It has a prevalence of 1% to 2% of the general population and is especially frequent in men and the population older than 60. In the last decade, RBD has been suggested to be a prodrome of neurodegenerative disease. We analysed associated neurological diseases and responses to drug treatment in 33 patients with RBD treated in the multidisciplinary sleep disorders unit at Hospital Infanta Sofía. PATIENTS AND METHODS We conducted an observational descriptive retrospective analysis of patients diagnosed with RBD and treated in our multidisciplinary sleep disorders unit between October 2012 and December 2015. We recorded age, sex, associated diseases, and treatments administered to these patients. RESULTS A total of 365 patients were attended at our unit, including 33 with RBD: 13 women (40%) and 20 men (60%). Mean age was 62.72 years. An associated disorder was identified in 48%, with the most common being mild cognitive impairment (69%). The percentage of patients with RBD and an associated disorder among patients older than 60 was 68%. Eighty-two percent of the patients required treatment. The most commonly used drug was clonazepam (76%), followed by melatonin (9%), gabapentin (6%), and trazodone (3%). DISCUSSION In our series, 48% of the patients had an associated disorder. The likelihood of detecting an associated disorder increases with patients' age. The vast majority of patients required drug treatment due to symptom severity; the most frequently administered drug was clonazepam (76%).
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Affiliation(s)
- M J Abenza Abildúa
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - A Miralles Martinez
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - F J Arpa Gutiérrez
- Servicio de Neurología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - V Lores Gutiérrez
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
| | - C Algarra Lucas
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - C Jimeno Montero
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - B Sánchez García
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
| | - M Mata Álvarez-Santullano
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - C Borrue Fernández
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - G Cordero Martín
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - G Gutiérrez Cueto
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
| | - M D Torrecillas Narváez
- Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - I Thuissard Vasallo
- Servicio de Estadística, Universidad Europea de Madrid, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - A Gómez Aceña
- Sección de Neumología, Centro de Medicina del Sueño, San Sebastián de los Reyes, Madrid, España
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Lee K, Baron K, Soca R, Attarian H. The Prevalence and Characteristics of REM Sleep without Atonia (RSWA) in Patients Taking Antidepressants. J Clin Sleep Med 2017; 12:351-5. [PMID: 26446247 DOI: 10.5664/jcsm.5582] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/13/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The association of REM sleep without atonia (RSWA) as well as REM sleep behavior disorder (RBD) with the intake of selective serotonin reuptake inhibitors (SSRI) and selective norepinephrine reuptake inhibitors (SNRI) is well established. Our study objective was to determine the prevalence of RSWA and RBD among a group of sleep center patients taking SSRI and SNRI. METHODS A retrospective chart review was done at our tertiary sleep center, and 10,746 consecutive records from October 1, 2007, through October 31, 2013, were searched for SSRI and SNRI names using the Sleep Cataloguer Software. RESULTS The search resulted in 1,444 records, which were then reviewed for keywords of RSWA and RBD. The AASM scoring criteria were used to determine RSWA. Reports of 41 patients with known narcolepsy or α-synucleinopathies were excluded. The remaining records were mined for age, sex, presence of obstructive sleep apnea (OSA), type of antidepressant (SSRI or SNRI), and diagnosis for which antidepressant was prescribed. We used logistic regression analysis to adjust for age, OSA, and sex. Of the 1,444 participants on antidepressants, 176 (12.2%) had RSWA (all confirmed by the investigators) compared to 226 of the entire sleep lab population of 10,746 (2.1%), risk ratio (95% CI) 9.978 (8.149, 12.22). Seven of the 176 patients on antidepressants had RBD (0.48%) compared to 108 of 10,746 (1%), p = 0.005. CONCLUSIONS SSRI and SNRI are associated with a higher prevalence of RSWA but not of RBD. This is independent of medication type.
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Affiliation(s)
- Kenneth Lee
- Northwestern University Feinberg School of Medicine, Chicago IL
| | - Kelly Baron
- Northwestern University Feinberg School of Medicine, Chicago IL
| | - Rodolfo Soca
- Northwestern University Feinberg School of Medicine, Chicago IL
| | - Hrayr Attarian
- Northwestern University Feinberg School of Medicine, Chicago IL
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Tachibana N. Sleep related movement and behavior disorders. Rinsho Shinkeigaku 2016; 56:541-9. [PMID: 27477578 DOI: 10.5692/clinicalneurol.cn-000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Movement and behavior disorders developing during sleep or in the transitional state from sleep to wakefulness are mostly unfamiliar to Japanese neurologists, primarily because these disorders are objects of basic research. In addition, the patients with sleep related movement and behavior disorders (SRMBD) show no signs and symptoms in our consulting rooms, and cannot be identified without polysomnography (PSG) attended by trained sleep technologists. Although attended PSG is not widely available in Japan, some kinds of SRMBD ought to be clinical targets for neurologists, and they are the scope of this review.
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Affiliation(s)
- Naoko Tachibana
- Division of Sleep Medicine, Kansai Electric Power Medical Research Institute
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The utility of respiratory inductance plethysmography in REM sleep scoring during multiple sleep latency testing. Respir Physiol Neurobiol 2016; 230:1-4. [DOI: 10.1016/j.resp.2016.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/26/2016] [Indexed: 11/23/2022]
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Abstract
How does the brain control dreams? New science shows that a small node of cells in the medulla - the most primitive part of the brain - may function to control REM sleep, the brain state that underlies dreaming.
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Affiliation(s)
- John Peever
- Departments of Cell and Systems Biology and Physiology, University of Toronto, Toronto, ON, M5S 3G5, Canada.
| | - Patrick M Fuller
- Department of Neurology, Beth Israel Deaconess Medical Center and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, USA.
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Irfan M, Howell MJ. Rapid Eye Movement Sleep Behavior Disorder: Overview and Current Perspective. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0038-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Beyond Daytime Sleepiness: Medical, Behavioral, Psychiatric, and Sleep Co-morbid Conditions Associated with Pediatric Narcolepsy. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0032-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Sutton EL. Profile of suvorexant in the management of insomnia. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:6035-42. [PMID: 26648692 PMCID: PMC4651361 DOI: 10.2147/dddt.s73224] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Suvorexant, approved in late 2014 in the United States and Japan for the treatment of insomnia characterized by difficulty achieving and/or maintaining sleep, is a dual orexin receptor antagonist and the first drug in its class to reach the market. Its development followed from the 1998 discovery of orexins (also called hypocretins), excitatory neuropeptides originating from neurons in the hypothalamus involved in regulation of sleep and wake, feeding behavior and energy regulation, motor activity, and reward-seeking behavior. Suvorexant objectively improves sleep, shortening the time to achieve persistent sleep and reducing wake after sleep onset, although at approved doses (≤20 mg) the benefit was subjectively assessed as modest. Its half-life of 12 hours is relatively long for a modern hypnotic; however, at approved doses (≤20 mg) next-day sedation and driving impairment were much less apparent than at higher doses. Suvorexant is metabolized by the hepatic CYP3A system and should be avoided in combination with strong CYP3A inhibitors. Drug levels are higher in women and obese people; hence, dosing should be conservative in obese women. Administration with food delays drug absorption and is not advised. No dose adjustment is needed for advanced age, renal impairment, or mild-to-moderate hepatic impairment. Suvorexant in contraindicated in narcolepsy and has not been studied in children. In alignment with the changes begun in 2013 in the labeling of other hypnotics, the United States Food and Drug Administration advises that the lowest dose effective to treat symptoms be used and that patients be advised of the possibility of next-day impairment in function, including driving. Infrequent but notable side effects included abnormal dreams, sleep paralysis, and suicidal ideation that were dose-related and reported to be mild. Given its mechanism of action, cataplexy and rapid eye movement (REM) sleep behavior disorder could potentially occur in some patients taking this medication.
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Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, Seattle, WA, USA
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Khan Z, Trotti LM. Central Disorders of Hypersomnolence: Focus on the Narcolepsies and Idiopathic Hypersomnia. Chest 2015; 148:262-273. [PMID: 26149554 DOI: 10.1378/chest.14-1304] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The central disorders of hypersomnolence are characterized by severe daytime sleepiness, which is present despite normal quality and timing of nocturnal sleep. Recent reclassification distinguishes three main subtypes: narcolepsy type 1, narcolepsy type 2, and idiopathic hypersomnia (IH), which are the focus of this review. Narcolepsy type 1 results from loss of hypothalamic hypocretin neurons, while the pathophysiology underlying narcolepsy type 2 and IH remains to be fully elucidated. Treatment of all three disorders focuses on the management of sleepiness, with additional treatment of cataplexy in those patients with narcolepsy type 1. Sleepiness can be treated with modafinil/armodafinil or sympathomimetic CNS stimulants, which have been shown to be beneficial in randomized controlled trials of narcolepsy and, quite recently, IH. In those patients with narcolepsy type 1, sodium oxybate is effective for the treatment of both sleepiness and cataplexy. Despite these treatments, there remains a subset of hypersomnolent patients with persistent sleepiness, in whom alternate therapies are needed. Emerging treatments for sleepiness include histamine H3 antagonists (eg, pitolisant) and possibly negative allosteric modulators of the gamma-aminobutyric acid-A receptor (eg, clarithromycin and flumazenil).
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Affiliation(s)
- Zeeshan Khan
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA
| | - Lynn Marie Trotti
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA.
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Abstract
PURPOSE OF REVIEW To describe the multiple clinical aspects of hypersomnias of central origin. Emphasis is given to the new pathophysiological pathways and treatment options described in the current literature. RECENT FINDINGS Narcolepsy is the most recognized of the hypersomnias of central origin. Hypocretin deficiency appears to underlie narcolepsy with cataplexy, and infections and vaccinations have been associated with disease onset. Targeted therapeutic approaches are currently underway. A putative naturally occurring constituent in the cerebrospinal fluid of patients with non-narcoleptic primary hypersomnias, able to stimulate γ-aminobutyric acid alpha receptors and induce sleep, has recently been postulated. Neuroimaging has also provided more insight into the pathophysiology of Kleine-Levin syndrome. Sleep deprivation is currently recognized as a major differential diagnosis. SUMMARY Excessive daytime sleepiness is the cardinal symptom of the hypersomnias of central origin, with major impact on the quality of life. It is important that clinicians be able to recognize these conditions, so that appropriate management or onward referral is expedited.
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Ylikoski A, Martikainen K, Sarkanen T, Partinen M. Parkinson's disease and narcolepsy-like symptoms. Sleep Med 2015; 16:540-4. [DOI: 10.1016/j.sleep.2014.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 11/25/2014] [Accepted: 12/29/2014] [Indexed: 01/10/2023]
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Zhou J, Zhang J, Li Y, Du L, Li Z, Lei F, Wing YK, Kushida CA, Zhou D, Tang X. Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China. Sleep Med 2015; 16:414-8. [DOI: 10.1016/j.sleep.2014.10.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/12/2014] [Accepted: 10/14/2014] [Indexed: 11/25/2022]
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Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med 2015; 16:9-18. [PMID: 25458251 DOI: 10.1016/j.sleep.2014.10.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Michael J Thorpy
- Sleep-Wake Disorders Center, Montefiore Medical Center, Bronx, NY, USA.
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM U1061, France
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Alakuijala A, Sarkanen T, Partinen M. Polysomnographic and actigraphic characteristics of patients with H1N1-vaccine-related and sporadic narcolepsy. Sleep Med 2014; 16:39-44. [PMID: 25554349 DOI: 10.1016/j.sleep.2014.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/26/2014] [Accepted: 07/17/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE After the pandemic H1N1 influenza ASO3-adjuvanted vaccine, Pandemrix©, was used in late 2009 and early 2010, the incidence of narcolepsy increased in many European countries. This incidence mainly increased in children and adolescents and, to a lesser degree, in adults. PATIENTS/METHODS 125 unmedicated patients, aged 4 to 61 years, were included in this case-series study. Of these, 69 were diagnosed to have an H1N1-vaccine-related narcolepsy and 57 had sporadic narcolepsy. Most of these patients had: an actigraphy recording of 1-2 weeks, polysomnography, a Multiple Sleep Latency Test (MSLT), and cerebrospinal fluid hypocretin-1 concentration analysis. RESULTS Patients with H1N1-vaccine-related narcolepsy had shorter diagnostic delays, lower periodic leg movement index during sleep, earlier sleep-wake rhythm, and were younger in age at diagnosis, compared with sporadic cases. They also had shorter sleep latency and more sleep onset REM periods in MSLT, but these results were strongly age-dependent. Actigraphy showed quantitatively less sleep and more sleep fragmentation than polysomnography. CONCLUSION Regarding polysomnographic and actigraphic characteristics, there were no dramatic deviations between H1N1-vaccine-related and sporadic narcolepsy. Circadian rhythms indicated some interesting new findings with respect to the H1N1-vaccine-related disease. An actigraphy recording of 1-2 weeks is useful when studying the nocturnal aspects of narcolepsy and sleep-wake rhythms of narcoleptic patients.
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Affiliation(s)
- Anniina Alakuijala
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland; Department of Neurological Sciences, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland.
| | - Tomi Sarkanen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland; Department of Neurology, The Central Finland Central Hospital, Jyväskylä, Finland
| | - Markku Partinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
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Klein G, Burghaus L, Vaillant M, Pieri V, Fink GR, Diederich N. Dysautonomia in narcolepsy: evidence by questionnaire assessment. J Clin Neurol 2014; 10:314-9. [PMID: 25324880 PMCID: PMC4198712 DOI: 10.3988/jcn.2014.10.4.314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose Excessive daytime sleepiness and sudden sleep attacks are the main features of narcolepsy, but rapid-eye-movement sleep behavior disorder (RBD), hyposmia, and depression can also occur. The latter symptoms are nonmotor features in idiopathic Parkinson's disease (IPD). In the present study, IPD-proven diagnostic tools were tested to determine whether they are also applicable in the assessment of narcolepsy. Methods This was a case-control study comparing 15 patients with narcolepsy (PN) and 15 control subjects (CS) using the Scales for Outcomes in Parkinson's Autonomic Test (SCOPA-AUT), Parkinson's Disease Nonmotor Symptoms (PDNMS), University of Pennsylvania Smell Test, Farnsworth-Munsell 100 Hue test, Beck Depression Inventory, and the RBD screening questionnaire. Results Both the PN and CS exhibited mild hyposmia and no deficits in visual tests. Frequent dysautonomia in all domains except sexuality was found for the PN. The total SCOPA-AUT score was higher for the PN (18.47±10.08, mean±SD) than for the CS (4.40±3.09), as was the PDNMS score (10.53±4.78 and 1.80±2.31, respectively). RBD was present in 87% of the PN and 0% of the CS. The PN were more depressed than the CS. The differences between the PN and CS for all of these variables were statistically significant (all p<0.05). Conclusions The results of this study provide evidence for the presence of dysautonomia and confirm the comorbidities of depression and RBD in narcolepsy patients. The spectrum, which is comparable to the nonmotor complex in IPD, suggests wide-ranging, clinically detectable dysfunction beyond the narcoleptic core syndrome.
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Affiliation(s)
- Gilles Klein
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg. ; Department of Internal Medicine, Brothers of Charity Hospital, Trier, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Michel Vaillant
- Competences Center for Methodology and Statistics, CRP Santé, Strassen, Luxembourg
| | - Vannina Pieri
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg
| | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, Cologne, Germany. ; Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, Juelich, Germany
| | - Nico Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg. ; Department of Neurology, University Hospital of Cologne, Cologne, Germany
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Morrison I, Rumbold JM, Riha RL. Medicolegal aspects of complex behaviours arising from the sleep period: A review and guide for the practising sleep physician. Sleep Med Rev 2014; 18:249-60. [DOI: 10.1016/j.smrv.2013.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 07/26/2013] [Accepted: 07/27/2013] [Indexed: 11/16/2022]
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A case of REM sleep behavior disorder, narcolepsy-cataplexy, parkinsonism, and rheumatoid arthritis. Behav Neurol 2014; 2014:572931. [PMID: 24825961 PMCID: PMC4006621 DOI: 10.1155/2014/572931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/13/2013] [Indexed: 11/24/2022] Open
Abstract
A patient is reported in whom signs and symptoms of REM sleep behavior disorder (RBD) and narcolepsy have been associated for almost two decades with a late development of parkinsonism and rheumatoid arthritis. A 78-year-old male patient in whom RBD was first diagnosed was followed-up by clinical examination, video-polysomnography, multiple sleep latency test, cerebral magnetic resonance imaging, and dopamine transporter imaging by single-photon emission computerized tomography. The patient was found to present for almost two decades, in addition to RBD, also narcolepsy. Moreover, a late development of parkinsonism and the occurrence of rheumatoid arthritis were detected and clinically and instrumentally characterized. Patients predisposed to RBD and later parkinsonism might be susceptible to a variety of triggers that, in our patient, might have been represented by a possible latent autoimmune process leading to the development of narcolepsy with cataplexy and rheumatoid arthritis, later.
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Abstract
Despite the classic tetrad of clinical features that typify it, narcolepsy remains much under-diagnosed, in part, because of the wide spectrum of clinical phenotypes, but also because of its insidious onset, usually in a young person. The median time to diagnosis from first symptoms remains very long, around 10 years in the UK. Conversely, in the specialist setting, it is likely over-diagnosed, largely because of failure to exclude other causes of hypersomnia. There is an over-reliance on a biological marker of the condition, the multiple sleep latency test (MSLT), which, like many tests, has a significant false-positive and false-negative rate. This review aims to discuss some of the difficulties in achieving a diagnosis, interpretation of investigations, differential diagnosis, and appropriate management of patients with narcolepsy.
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Kumar S, Sagili H. Etiopathogenesis and neurobiology of narcolepsy: a review. J Clin Diagn Res 2013; 8:190-5. [PMID: 24701532 DOI: 10.7860/jcdr/2014/7295.4057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/28/2013] [Indexed: 12/26/2022]
Abstract
Narcolepsy is a chronic lifelong sleep disorder and it often leaves a debilitating effect on the quality of life of the sufferer. This disorder is characterized by a tetrad of excessive daytime sleepiness, cataplexy (brief loss of muscle tone following strong emotion), hypnogogic hallucinations and sleep paralysis. There are two distinct subgroups of Narcolepsy: Narcolepsy with cataplexy and Narcolepsy without cataplexy. For over 100 years, clinicians have recognised narcolepsy, but only in the last few decades have scientists been able to shed light on the true cause and pathogenesis of narcolepsy. Recent studies have shown that a loss of the hypothalamic neuropeptide Hypocretin/Orexincauses Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss. Our understanding of the neurophysiologic aspect of narcolepsy has also significantly improved. The basic neural mechanisms behind sleepiness and cataplexy, the two defining symptoms of narcolepsy have started to become clearer. In this review, we have provided a detailed account of the key aspects of etiopathogenesis and neurobiology of narcolepsy, along with a critical appraisal of the more recent and interesting causal associations.We have also looked at the contributions of neuroimaging to the etiopathogenesis of Narcolepsy.
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Affiliation(s)
- Swarup Kumar
- Intern, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , India
| | - Haritha Sagili
- Associate Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , India
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