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Wang XX, Feng Y, Tan EK, Ondo WG, Wu YC. Stroke-related restless legs syndrome: epidemiology, clinical characteristics and pathophysiology. Sleep Med 2022; 90:238-248. [DOI: 10.1016/j.sleep.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/23/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022]
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2
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Bailey GA, Hubbard EK, Fasano A, Tijssen MA, Lynch T, Anderson KN, Peall KJ. Sleep disturbance in movement disorders: insights, treatments and challenges. J Neurol Neurosurg Psychiatry 2021; 92:723-736. [PMID: 33741740 DOI: 10.1136/jnnp-2020-325546] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
Sleep and circadian rhythm disturbances are central features of many movement disorders, exacerbating motor and non-motor symptoms and impairing quality of life. Understanding these disturbances to sleep is clinically important and may further our understanding of the underlying movement disorder. This review evaluates the current anatomical and neurochemical understanding of normal sleep and the recognised primary sleep disorders. In addition, we undertook a systematic review of the evidence for disruption to sleep across multiple movement disorders. Rapid eye movement sleep behaviour disorder has emerged as the most reliable prodromal biomarker for the alpha synucleinopathies, including Parkinson's disease and multiple system atrophy, often preceding motor symptom onset by several years. Abnormal sleep has also been described for many other movement disorders, but further evidence is needed to determine whether this is a primary or secondary phenotypic component of the underlying condition. Medication used in the treatment of motor symptoms also affects sleep and can aggravate or cause certain sleep disorders. Within the context of movement disorders, there is also some suggestion of a shared underlying mechanism for motor and sleep pathophysiology, with evidence implicating thalamic and brainstem structures and monoaminergic neurotransmission. This review highlights the need for an understanding of normal and abnormal sleep within the movement disorder clinic, an ability to screen for specific causes of poor sleep and to treat sleep disturbance to improve quality of life. Key sleep disorders also act as important biomarkers and have implications in diagnosis, prognosis and the development of future therapies.
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Affiliation(s)
- Grace A Bailey
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Emily K Hubbard
- School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
| | - Alfonso Fasano
- Edmond J Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Timothy Lynch
- Dublin Neurological Institute, The Mater Misericordiae University Hospital, Dublin, Dublin, Ireland
| | - Kirstie N Anderson
- Department of Neurology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
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Hermann W, Flemming T, Brandt MD, Langner S, Reichmann H, Storch A. Asymmetry of Periodic Leg Movements in Sleep (PLMS) in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:255-266. [PMID: 31609696 DOI: 10.3233/jpd-191667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Periodic limb movements in sleep (PLMS) are repetitive movements usually of the legs strongly associated with Restless-legs syndrome (RLS), which appear more frequently in males, older age and other sleep disturbances, such as sleep-disordered breathing (SDB). Patients with Parkinson's disease (PD) suffer from various sleep disturbances including REM sleep behavior disorder, RLS and PLMS. Although a dopaminergic pathophysiology of PLMS is discussed, no systematic data on PLMS side-to-side distribution in PD and its correlation with asymmetry of motor symptoms are available. OBJECTIVE This study aimed at elucidating PLMS asymmetry in correlation to that of motor symptoms in PD compared to SDB and RLS. METHODS Cross-sectional, retrospective analysis of two polysomnography (PSG) recordings per patient scoring PLMS separately for both legs. RESULTS Of 105 patients (44 PD, 44 age- and sex-matched SDB and 17 RLS patients) PLMS measures (number of PLM, PLM-Index, PLM-arousal index) showed significant side-to-side differences in all disease entities in both PSGs (P < 0.001; Wilcoxon rank test). PLM-Index asymmetry (PLM-I difference of >5/h between both sides) was observed less frequently in PD (34% of patients) compared to RLS (77% , P < 0.05) and SDB (59% , P < 0.05; χ2 test). In asymmetric PD patients, predominant side of PLMS was more stable than in SDB and RLS comparing the two PSGs, but we did not detect an agreement between PLMS predominant side with that of motor symptoms in PD patients. CONCLUSIONS Only the minority of PD patients shows asymmetric PLMS distribution with relatively high night-to-night stability but no correlation with motor symptom asymmetry.
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Affiliation(s)
- Wiebke Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
| | - Theresa Flemming
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Moritz D Brandt
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Simona Langner
- Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
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4
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Overview of sleep disturbances and their management in Parkinson plus disorders. J Neurol Sci 2020; 415:116891. [DOI: 10.1016/j.jns.2020.116891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
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5
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Högl B, Stefani A. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations. Mov Disord 2017; 32:669-681. [DOI: 10.1002/mds.26929] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Birgit Högl
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - Ambra Stefani
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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6
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Losurdo A, Luigetti M, Restuccia D, Vollono C, Testani E, Gnoni V, Di Blasi C, Della Marca G. Restless Legs Syndrome and lateralized periodic movements due to a spinal schwannoma. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Losurdo
- Institute of Neurology; Catholic University; Rome Italy
| | | | | | | | - Elisa Testani
- Institute of Neurology; Catholic University; Rome Italy
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7
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Abstract
Sleep disorders are commonly seen in atypical parkinsonism, with particular disorders occurring more frequently in specific parkinsonian disorders. Multiple systems atrophy (MSA) is a synucleinopathy often associated with nocturnal stridor which is a serious, but treatable condition highly specific to MSA. In addition, this disorder is strongly associated with rapid eye movement (REM) sleep behavior disorder (RBD), which is also seen in dementia with Lewy bodies (DLB). RBD is far less prevalent in progressive supranuclear palsy (PSP), which is a tauopathy. Insomnia and impaired sleep architecture are the most common sleep abnormalities seen in PSP. Corticobasilar degeneration (CBD) is also a tauopathy, but has far fewer sleep complaints associated with it than PSP. In this manuscript we review the spectrum of sleep dysfunction across the atypical parkinsonian disorders, emphasize the importance of evaluating for sleep disorders in patients with parkinsonian symptoms, and point to sleep characteristics that can provide diagnostic clues to the underlying parkinsonian disorder.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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8
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Benbir G, Karadeniz D. Influence of periodic leg movements in sleep on stroke outcome. Sleep Biol Rhythms 2013. [DOI: 10.1111/sbr.12021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gulcin Benbir
- Department of Neurology; Sleep and Its Disorders Unit; Faculty of Medicine; Istanbul University Cerrahpasa; Istanbul; Turkey
| | - Derya Karadeniz
- Department of Neurology; Sleep and Its Disorders Unit; Faculty of Medicine; Istanbul University Cerrahpasa; Istanbul; Turkey
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9
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Ferri R. The time structure of leg movement activity during sleep: The theory behind the practice. Sleep Med 2012; 13:433-41. [DOI: 10.1016/j.sleep.2011.10.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 10/07/2011] [Accepted: 10/31/2011] [Indexed: 10/14/2022]
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10
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Benbir G, Karadeniz D. Periodic leg movements in sleep in patients with supratentorial cerebral infarction. Acta Neurol Belg 2012; 112:27-32. [PMID: 22427286 DOI: 10.1007/s13760-011-0002-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 09/19/2011] [Indexed: 11/28/2022]
Abstract
The pathophysiology of periodic leg movements in sleep (PLMS) is complex, and still lacks a consensus. Consecutive 35 patients with the diagnosis of acute supratentorial ischemic stroke and 35 age- and sex-matched control subjects were prospectively investigated. Clinical and sociodemographic evaluation and a whole-night polysomnographic recording were performed. In patients with supratentorial ischemic stroke, 27 patients (77.2%) had PLMS-index more than 5/h, and 19 out of 35 patients (54.3%) had PLMS-index more than 15/h; while only 10 participants (28.5%) in control group had PLMS-index more than 5/h, and 6 participants (17.1%) had PLMS-index more than 15/h (p < 0.05). None of the demographic variables showed statistically significant relationship with PLMS, such as gender (p = 0.952) and age (p = 0.435). Territorial localization of ischemic lesions showed no relation with the presence of PLMS (p = 0.867), PLMS-index (p = 0.432), or restless legs syndrome (p = 0.833). All patients demonstrated PLMS contralateral to ischemic lesion except eight patients with bilateral PLMS; these were also more prominent contralaterally. Our study supports the hypothesis that destructive lesions causing the loss of cortical or subcortical inhibition exerting on the reticular formation on spinal pathways could lead to the development of PLMS.
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Affiliation(s)
- Gulcin Benbir
- Sleep Disorders Unit, Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
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11
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Auger RR, Boeve BF. Sleep disorders in neurodegenerative diseases other than Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2011; 99:1011-1050. [PMID: 21056241 DOI: 10.1016/b978-0-444-52007-4.00020-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- R Robert Auger
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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12
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Kiferle L, Tognoni G, Maestri M, Rossi C, Unti E, Di Coscio E, Bonanni E, Ceravolo R. Unilateral periodic limb movements: Is this a pointer for atypical presentation of corticobasal degeneration syndrome?âA case report. Mov Disord 2009; 24:2298-9. [DOI: 10.1002/mds.22822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lee SJ, Kim JS, Song IU, An JY, Kim YI, Lee KS. Poststroke restless legs syndrome and lesion location: anatomical considerations. Mov Disord 2009; 24:77-84. [PMID: 18816657 DOI: 10.1002/mds.22303] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Several case studies have reported on restless legs syndrome (RLS) associated with stroke. In this study, we investigated the prevalence and the lesion topography of poststroke RLS. There were 137 patients with ischemic stroke included in this study. The diagnosis of RLS was made 1 month after the index stroke using the criteria established by the International RLS Study Group. All patients enrolled underwent magnetic resonance imaging within 7 days of the onset of the stroke. The prevalence of stroke-related RLS was calculated, and the topography of the associated ischemic lesions was analyzed. Among 137 patients, 17 patients (12.4%) were diagnosed with RLS after a stroke. Stroke-related RLS was found in 10 out of 33 patients with a basal ganglia/corona radiata infarct (30.3%), 1 out of 8 patients with an internal capsular infarct (12.5%), and 1 out of 7 patients with a thalamic infarct (14.3%). In addition, one out of 54 with a cortical lesion with/without subcortical involvement (1.9%), and 4 out of 18 patients with a pontine lesion (22.2%) had RLS. The analysis of the lesions in the cortical and subcortical group showed only 1 patient in the cortical group had stroke-related RLS, whereas 16 in the subcortical group had stroke-related RLS. The results of this study suggest that lesions of the subcortical brain areas such as the pyramidal tract and the basal ganglia-brainstem axis, which are involved in motor functions and sleep-wake cycles, may lead to RLS symptoms in patients after an ischemic stroke.
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Affiliation(s)
- Seung-Jae Lee
- Department of Neurology, The Catholic University of Korea, Seoul, Korea
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14
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Valko PO, Siccoli MM, Bassetti CL. Unilateral RLS with predominantly ipsilateral PLMS and variable response to dopaminergic drugs: a variant of idiopathic RLS? Eur J Neurol 2009; 16:430-2. [DOI: 10.1111/j.1468-1331.2008.02526.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Hauw JJ, Hausser-Hauw C, Hasboun D, Seilhean D. [The neuropathology of sleep in human neurodegenerative diseases]. Rev Neurol (Paris) 2008; 164:669-82. [PMID: 18760429 DOI: 10.1016/j.neurol.2008.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 07/07/2008] [Indexed: 11/16/2022]
Abstract
The neuropathology of human sleep remains an ill-defined issue. The data concerning the main structures of human brain areas involved, or supposed to be implicated, in sleep organisation are reviewed. Five levels of organisation can be schematically recognized: (i) the ascending arousal system, (ii) the non REM and REM systems (iii) regulated by hypothalamic areas, (iv) and the biological clock, (v) modulated by a number of "allostatic" influences. These are briefly described, with emphasis on the location of structures involved in humans, and on the recently revised concepts. Current knowledge on the topography of lesions associated with the main sleep disorders in degenerative diseases is recalled, including REM sleep behavior disorders, restless legs syndrome and periodic leg movements, sleep apneas, insomnia, excessive daily sleepiness, secondary narcolepsy and disturbed sleep-wake rhythms. The lesions of sleep related structures observed in early and late stages of four degenerative diseases are then reviewed. Two synucleinopathies (Lewy lesions associated disorders, including Parkinson's disease and Dementia with Lewy bodies, and Multiple System Atrophy) and two tauopathies (Progressive Supranuclear Palsy and Alzheimer's disease) are dealt with. The distribution of lesions usually found in affected patients fit with that expected from the prevalence of different sleep disorders in these diseases. This confirms the current opinion that these disorders depend on the distribution of lesions rather than on their biochemical nature. Further studies might throw insight on the mechanism of normal and pathological sleep in humans, counterpart of the increasing knowledge provided by animal models. Specially designed prospective clinicopathological studies including peculiar attention to sleep are urgently needed.
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Affiliation(s)
- J-J Hauw
- Laboratoire de neuropathologie Raymond-Escourolle, groupe hospitalier Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, Paris cedex 13, France.
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16
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Unilateral periodic leg movements during wakefulness and sleep after a parietal hemorrhage. Sleep Med 2008; 9:465-6. [DOI: 10.1016/j.sleep.2007.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 06/28/2007] [Accepted: 06/28/2007] [Indexed: 11/20/2022]
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17
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Tyvaert L, Cassim F, Derambure P, Defebvre L. Neurophysiologie de la dégénérescence corticobasale. Rev Neurol (Paris) 2007; 163:779-91. [PMID: 17878804 DOI: 10.1016/s0035-3787(07)91460-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Corticobasal degeneration (CBD) is a neurodegenerative disorder of mid- to late-adult life. From a clinical standpoint, CBD is characterized by (i) an insidious onset and a slowly progressing, unilateral, levodopa-unresponsive parkinsonian syndrome with dystonia or myoclonus and (ii) cerebral features such as apraxia, alien limb phenomena and cortical sensory loss. Decisive clinical diagnostic criteria are not available and thus a neuropathological study remains essential for accurate CBD diagnosis. Consequently, additional non-clinical criteria must be identified in order to improve diagnosis while patients are still alive. BACKGROUND Electrophysiological exploration can yield functional information on a number of brain structures (both cortical and sub-cortical) involved in CBD. The disorder features a specific cortical (frontoparietal) alteration which could help with differential diagnoses for other extrapyramidal syndromes. Hence, exploration of a patient's myoclonus can provide some specific arguments for CBD. Indeed, myoclonus displays a number of clinical and electromyographical characteristics which are consistent with a cortical origin (a shorter latency of the cortical C response, for example). However, some typical cortical features are missing (giant somesthesic evoked potentials, and cortical potentials preceding myoclonus in jerk-locked back-averaging studies). Some authors explain these abnormalities in terms of a sub-cortical origin for the myoclonus. The frontoparietal alteration in CBD has also been explored in studies of oculomotor movement. Indeed, asymmetric lengthening of the lateral ocular saccade latency argues more in favour of CBD than progressive supranuclear palsy. Moreover, cognitive function is also compromised in the early stages of CBD, although it is sometimes difficult to distinguish between CBD, PSP and frontotemporal dementia. Studying cognitive potentials enables one to confirm subcorticofrontal abnormalities and to dissociate CBD patterns from PSP patterns. Other electrophysiological tests (such as the exploration of dysautonomia, the palmomental reflex and the blink reflex) produce results which overlap with those seen in extrapyramidal syndromes and synucleinopathies (polysomnography), prompting discussion of the physiopathological mechanisms of these various diseases. CONCLUSION Electrophysiological exploration is of value for diagnosing CBD in general and for studying specific, frontoparietal dysfunctions in particular. These techniques could also significantly contribute to our understanding of the physiopathology of CBD.
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Affiliation(s)
- L Tyvaert
- Service de Neurophysiologie Clinique, EA 2683, IFR 114, Hôpital Roger Salengro, 59037 Lille Cedex
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18
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Roche S, Jacquesson JM, Destée A, Defebvre L, Derambure P, Monaca C. Sleep and vigilance in corticobasal degeneration: a descriptive study. Neurophysiol Clin 2007; 37:261-4. [PMID: 17996814 DOI: 10.1016/j.neucli.2007.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 05/09/2007] [Accepted: 05/17/2007] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Sleep disorders are common in extrapyramidal diseases, but have rarely been demonstrated in corticobasal degeneration (CBD). METHODS Here, we describe sleep and vigilance in five consecutive patients with CBD. RESULTS All five patients had insomnia, four displayed periodic limb movements during sleep (PLMS) and/or restless leg syndrome (RLS), and two had sleep respiratory disorders. None had REM sleep behaviour disorders or excessive daytime sleepiness. CONCLUSIONS Polysomnography is useful for diagnosing treatable sleep disorders in CBD.
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Affiliation(s)
- S Roche
- Department of Clinical Neurophysiology, Roger Salengro Hospital, EA 2683, Lille University Medical Center, 59037 Lille cedex, France
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19
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Kang SY, Sohn YH, Lee IK, Kim JS. Unilateral periodic limb movement in sleep after supratentorial cerebral infarction. Parkinsonism Relat Disord 2004; 10:429-31. [PMID: 15465401 DOI: 10.1016/j.parkreldis.2004.04.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Revised: 04/15/2004] [Accepted: 04/17/2004] [Indexed: 11/20/2022]
Abstract
We report a patient with involuntary right leg movements during sleep, which developed after acute ischemic stroke in the corona radiata. Nocturnal polysomnography confirmed the diagnosis of periodic limb movement in sleep (PLMS). Although the pathogenesis of PLMS is still controversial, it has been proposed that the loss of cortical or subcortical inhibition resulting from the pyramidal tract lesion might cause PLMS. The present case provides evidence to support this hypothesis.
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Affiliation(s)
- Suk Y Kang
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea
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20
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Abstract
Parkinson's disease is associated with classical Parkinsonian features that respond to dopaminergic therapy. Neuropsychiatric sequelae include dementia, major depression, dysthymia, anxiety disorders, sleep disorders, and sexual disorders. Panic attacks are particularly common. With treatment, visual hallucinations, paranoid delusions, mania, or delirium may evolve. Psychosis is a key factor in nursing home placement, and depression is the most significant predictor of quality of life. Clozapine may be the safest treatment for psychotic features, but more research is needed to establish the efficacy of antidepressant treatments. Dementia with Lewy bodies, the second most common dementia in the elderly, may present in association with systematized delusions, depression, or RBD. Early evidence suggests the utility of rivastigmine, donepezil, low-dose olanzapine, and quetiapine in treating DLB. Parkinson-plus syndromes generally lack a good response to dopaminergic treatment and evidence additional features, including dysautonomia, cerebellar and pontine features, eye signs, and other movement disorders. MSA is associated with dysautonomia and RBD. SND (MSA-P) is associated with frontal cognitive impairments, but dementia, psychosis, and mood disorders have not been strikingly apparent unless additional pathological findings are present. In SDS (MSA-A), impotence is almost ubiquitous; urinary incontinence is frequent; depression is occasional, and sleep apnea should be treated to avoid sudden death during sleep. OPCA neuropsychiatric correlates await further definition. Progressive supranuclear palsy neuropsychiatric features include apathy, subcortical dementia, pathological emotionality, mild depression and anxiety, and lack of appreciable response to donepezil. CBD usually is recognized by early frontal dementia with ideomotor apraxia, often in the right upper extremity, attended later by poorly responsive unilateral Parkinsonism, with additional signs including cortical reflex myoclonus, limb dystonia, alien limb, oculomotor apraxia when asked to look horizontally, depression, personality changes, and, occasionally, Kluver-Bucy syndrome. The neuropsychiatry of FTDP-17 involves apraxia, executive impairment, personality changes, hyperorality, and occasional psychosis. Future research in these Parkinsonian disorders should target the characterization of neuropsychiatric sequelae and their treatment.
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Affiliation(s)
- Edward C Lauterbach
- Division of Adult and Geriatric Psychiatry, Mercer University School of Medicine, 655 First Street, Macon, GA 31201, USA.
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