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Ingravallo F, D'Alterio A, Rossetti A, Antelmi E, Plazzi G. Disclosing the Risk Associated with Isolated REM Behavior Disorder: The Sleep Experts' Perspective. Mov Disord Clin Pract 2024; 11:488-495. [PMID: 38341655 PMCID: PMC11078490 DOI: 10.1002/mdc3.13998] [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: 07/24/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Isolated rapid-eye-movement sleep behavior disorder (iRBD) is associated with a high risk for phenoconversion to a neurodegenerative disorder, but the optimal approach for disclosure of this risk to patients is still debated. OBJECTIVES The aim of this study was to explore views and experiences of iRBD experts regarding risk disclosure. METHODS In this qualitative study, semi-structured interviews with sleep experts caring for patients with iRBD were analyzed through a conventional content analysis approach. RESULTS We interviewed 22 iRBD experts (eight female, average age of 51.8 years) from 18 Italian sleep centers; 21/22 regularly disclosed the risks associated with iRBD, usually after the video-polysomnography, and 8/22 regularly mentioned phenoconversion rates. Content analysis allowed us to identify three main themes. First, sleep experts reported several points in favor of risk disclosure, especially related to the principle of beneficence, but some highlighted the need for specific learning on the topic. Second, experts favored a patient-tailored disclosure that should not upset the patient unnecessarily, since phenoconversion is uncertain. Third, risk disclosure was seen by participants as a relational task that should be carried out in person in the context of a trusting patient-physician relationship, while they had contrasting views regarding patients' previous knowledge. CONCLUSIONS Sleep experts generally preferred a tailored and reassuring approach to risk disclosure within a framework of relational autonomy. The results of this study indicate the need for specific education, training, and recommendations concerning risk disclosure that should also include patients' and families' preferences.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Alessandra D'Alterio
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Rossetti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Elena Antelmi
- Department of Engineering and Medicine of Innovation (DIMI)University of VeronaVeronaItaly
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
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Malkani R. Rapid Eye Movement Sleep Behavior Disorder: Management and Prognostic Counseling. Sleep Med Clin 2024; 19:83-92. [PMID: 38368072 DOI: 10.1016/j.jsmc.2023.12.001] [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] [Indexed: 02/19/2024]
Abstract
Management of rapid eye movement sleep behavior disorder (RBD) includes reducing injurious dream-enactment behaviors, risk of injury to self and bedpartner, and vivid or disruptive dreams and improving sleep quality and bedpartner sleep disruption. Safety precautions should be reviewed at each visit. Medications to reduce RBD symptoms such as melatonin, clonazepam, pramipexole, and rivastigmine should be considered for most patients. Isolated RBD confers a high lifetime risk of neurodegenerative diseases with a latency often spanning many years. A patient-centered shared decision-making approach to risk disclosure is recommended. Knowledge of the risk allows for life planning and participation in research.
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Affiliation(s)
- Roneil Malkani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Neurology Service, Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue, Damen Building, 9th Floor, Chicago, IL 60612, USA.
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3
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Leclair-Visonneau L, Feemster JC, Bibi N, Gossard TR, Jagielski JT, Strainis EP, Carvalho DZ, Timm PC, Bliwise DL, Boeve BF, Silber MH, McCarter SJ, St. Louis EK. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med 2024; 20:279-291. [PMID: 37823585 PMCID: PMC10835777 DOI: 10.5664/jcsm.10862] [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: 04/11/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVES Accurate diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial due to its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds applicable in varying clinical presentations in a contemporary cohort of patients with iRBD using submentalis (SM) and individual bilateral flexor digitorum superficialis (FDS) and anterior tibialis electromyography limb recordings during polysomnography. METHODS We analyzed RSWA in 20 patients with iRBD and 20 age-, REM-, apnea-hypopnea index-matched controls between 2017 and 2022 for phasic burst durations, density of phasic, tonic, and "any" muscle activity (number of 3-second mini-epochs containing phasic or tonic muscle activity divided by the total number of REM sleep 3-second mini-epochs), and automated Ferri REM atonia index (RAI). Group RSWA metrics were comparatively analyzed. Receiver operating characteristic curves determined optimized area under the curve (AUC) and maximized specificity and sensitivity diagnostic iRBD RSWA thresholds. RESULTS All mean RSWA metrics were higher in patients with iRBD than in controls (P < .05), except for selected anterior tibialis measures. Optimized, maximal specificity AUC diagnostic cutoffs for coprimary outcomes were: SM "any" 6.5%, 14.0% (AUC = 92.5%) and combined SM+FDS "any" 15.1%, 27.4% (AUC = 95.8%), while SM burst durations were 0.72, and 0.72 seconds (AUC 90.2%) and FDS RAI = 0.930, 0.888 (AUC 92.8%). CONCLUSIONS This study provides evidence for current quantitative RSWA diagnostic thresholds in chin and individual 4 limb muscles applicable in different iRBD clinical settings and confirms the key value of SM or SM+FDS to assure accurate iRBD diagnosis. Evolving iRBD recognition underscores the necessity of continuous assessment with future large, prospective, well-harmonized, multicenter polysomnographic analyses. CITATION Leclair-Visonneau L, Feemster JC, Bibi N, et al. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med. 2024;20(2):279-291.
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Affiliation(s)
- Laurène Leclair-Visonneau
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical Neurophysiology, CHU de Nantes, Nantes, France
- Nantes Université, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
| | - John C. Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Noor Bibi
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Thomas R. Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Jack T. Jagielski
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Emma P. Strainis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Diego Z. Carvalho
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Paul C. Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Donald L. Bliwise
- Emory Sleep Center and Department of Neurology, Emory University, Atlanta, Georgia
| | - Bradley F. Boeve
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Michael H. Silber
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Stuart J. McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Erik K. St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical and Translational Science, Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin
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4
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Pérez‐Carbonell L, Simonet C, Chohan H, Gill A, Leschziner G, Schrag A, Noyce AJ. The Views of Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder on Risk Disclosure. Mov Disord 2023; 38:1089-1093. [PMID: 37046409 PMCID: PMC10947281 DOI: 10.1002/mds.29403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/20/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Isolated rapid eye movement sleep behavior disorder (iRBD) is associated with an increased risk of Parkinson's disease and other synucleinopathies. There is no consensus about disclosure of this risk to patients with iRBD. OBJECTIVE The objective of our study was to assess the experiences of risk disclosure in a group of patients with iRBD and their views on what, when, and how this should be done. METHODS A survey was administered to patients with iRBD to explore their experiences and views on risk disclosure. RESULTS Thirty-one patients with iRBD (28 males; mean age, 70 [SD 8.7] years; mean disease duration, 8.7 [SD 6.4] years) were included. A third reported they had not been informed about the link between iRBD and other conditions by clinicians at diagnosis, but 90% would have liked to have received prognostic information, and 60% indicated that this should happen at the point that iRBD was diagnosed. Most participants wanted this information to come from the clinician diagnosing and treating iRBD (90.3%). Almost three-quarters (72.2%) had searched for this information online. CONCLUSIONS Patients with iRBD mostly wished to have received information regarding the potential implications of iRBD when the diagnosis was made. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Laura Pérez‐Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation TrustLondonUnited Kingdom
| | - Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUnited Kingdom
| | - Harneek Chohan
- Preventive Neurology Unit, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUnited Kingdom
| | - Aneet Gill
- Preventive Neurology Unit, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUnited Kingdom
| | - Guy Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation TrustLondonUnited Kingdom
| | - Anette Schrag
- Department of Clinical and Movement NeuroscienceUCL Institute of NeurologyLondonUnited Kingdom
| | - Alastair J. Noyce
- Preventive Neurology Unit, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUnited Kingdom
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Stefani A, Mozersky J, Kotagal V, Högl B, Ingravallo F, Ju YES, Avidan A, Sharp R, Videnovic A, Schenck CH, St Louis EK. Ethical Aspects of Prodromal Synucleinopathy Prognostic Counseling. Semin Neurol 2023; 43:166-177. [PMID: 36693433 DOI: 10.1055/a-2019-0245] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Alpha-synucleinopathies can be identified in their prodromal phase, raising several ethical issues. In this review, we first provide definitions of prodromal α-synucleinopathies and discuss the importance of distinguishing between prodromes and risk factors. Next, we discuss the implications of a diagnosis of prodromal α-synucleinopathy and considerations regarding prognostic counseling in both clinical and research settings. We review available data on patient preferences regarding disclosure as well as providers' perspectives. We examine the pros and cons of disclosing a diagnosis of prodromal α-synucleinopathy, taking into consideration the differences between clinical and research settings. Asking about willingness to know in clinical and research settings and the shared decision-making process applied to prognostic counseling is discussed. Concerning research settings, ethical aspects regarding clinical trials are addressed. Availability of direct-to-consumer technologies will likely lead to novel contexts requiring prognostic counseling, and future neuroprotective or neuromodulating treatments may require further considerations on the timing, role, and importance of prognostic counseling. Recommendations on how to address ethical gaps should be a priority for patients, medical professional societies, and research workgroups. Ethical issues must be considered as an integral part of the overall clinical and research approach to prodromal synucleinopathies.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Jessica Mozersky
- Division of General Medical Sciences, Washington University in Saint Louis, Saint Louis, Missouri
| | - Vikas Kotagal
- Department of Neurology, University of Michigan-Ann Arbor, Ann Arbor, Michigan
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Yo-El S Ju
- Division of General Medical Sciences, Washington University in Saint Louis, Saint Louis, Missouri
| | - Alon Avidan
- Department of Neurology, University of California-Los Angeles, Los Angeles, California
| | - Richard Sharp
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Aleksandar Videnovic
- Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Carlos H Schenck
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Erik K St Louis
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Gossard TR, Teigen LN, Yoo S, Timm PC, Jagielski J, Bibi N, Feemster JC, Steele T, Carvalho DZ, Junna MR, Lipford MC, Tippmann Peikert M, LeClair-Visonneau L, McCarter SJ, Boeve BF, Silber MH, Hirsch J, Sharp RR, St. Louis EK. Patient values and preferences regarding prognostic counseling in isolated REM sleep behavior disorder. Sleep 2023; 46:zsac244. [PMID: 36259668 PMCID: PMC9832520 DOI: 10.1093/sleep/zsac244] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/19/2022] [Indexed: 11/27/2022] Open
Abstract
STUDY OBJECTIVES Isolated REM sleep behavior disorder (iRBD) carries a high lifetime risk for phenoconversion to a defined neurodegenerative disease (NDD) including Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. We aimed to examine iRBD patient values and preferences regarding prognostic counseling. METHODS One hundred thirteen iRBD patient participants enrolled in the Mayo Clinic iRBD Patient Registry were sent an email survey concerning their values and preferences concerning NDD prognostic counseling and their experiences following diagnosis with iRBD. RESULTS Of 81 respondents (71.7% response rate), the majority were men (74.0%) with an average age of 65.7 (±9.7) years. Responses indicated a strong preference toward receiving prognostic information about possible future NDD development. 92.5% of respondents felt knowledge concerning personal NDD risk was important, while 87.6% indicated prognostic discussions were important to maintaining trust in their physician. 95.7% indicated a desire for more information, while only 4.3% desired less information regarding their NDD prognostic risk. Most respondents strongly agreed that prognostic information was important to discuss with their family and friends and inform future life planning, and most expressed interest in learning more about future neuroprotective therapies and symptomatic treatments for parkinsonism and dementia. CONCLUSIONS Most iRBD patients indicated strong preferences for disclosure of NDD prognostic risk and indicated that prognostic information was important for family discussions and future life planning. Future broader surveys and qualitative studies of clinic-based and ultimately community dwelling iRBD patients' values and preferences are needed to guide appropriately tailored and individualized prognostic counseling approaches following iRBD diagnosis.
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Affiliation(s)
- Thomas R Gossard
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Luke N Teigen
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Seeley Yoo
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Noor Bibi
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Tyler Steele
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Diego Z Carvalho
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Maja Tippmann Peikert
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | | | | | | | - Michael H Silber
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Jessica Hirsch
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Erik K St. Louis
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin, USA
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7
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Kayis G, Yilmaz R, Arda B, Akbostancı MC. Risk disclosure in prodromal Parkinson's disease - A survey of neurologists. Parkinsonism Relat Disord 2023; 106:105240. [PMID: 36516567 DOI: 10.1016/j.parkreldis.2022.105240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/14/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In the absence of a disease-modifying treatment and prognostic uncertainty, ethics of risk disclosure in prodromal Parkinson's disease (PD) is challenging. Previous studies highlighted several facets of these challenges from the perspective of involved parties. However, to date, the view of neurologists who may encounter individuals with prodromal PD remained unrepresented. Moreover, cross-cultural differences intrinsic to the ethics of risk disclosure are yet to be elucidated. Therefore, we investigated the attitude of neurologists toward risk disclosure in prodromal PD. METHODS In this observational study, Turkish neurologists were invited to fill out a questionnaire evaluating their stance on risk disclosure regarding an individual with polysomnography-confirmed REM sleep behavior disorder, which is the strongest risk factor for PD. RESULTS More than 90% of the participating 222 neurologists were familiar with prodromal PD. While 15.3% stated that the risk should be disclosed in any case, 6.8% chose no disclosure. The remaining 77.9% favored disclosure only under certain circumstances, the plurality of which was the individual's consent to know about the risk. After reminding the potential neuroprotective effects of exercise and diet, neurologists who chose the option of "no disclosure" decreased to 3.2% (McNemar's test p = 0.008). No significant differences among the neurologists were found regarding sex, academic title, or field of interest. CONCLUSION The majority of the neurologists found it appropriate to disclose the risk of future PD only if the individual expresses a desire to know. Also, recognition of the impact of lifestyle factors on PD is important in prognostic counseling.
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Affiliation(s)
- Gorkem Kayis
- Ankara University School of Medicine, Ankara, Turkey
| | - Rezzak Yilmaz
- Ankara University School of Medicine, Department of Neurology, Ankara, Turkey; Ankara University Brain Research Center, Ankara, Turkey.
| | - Berna Arda
- Ankara University School of Medicine, Department of History of Medicine and Ethics, Ankara, Turkey
| | - M Cenk Akbostancı
- Ankara University School of Medicine, Department of Neurology, Ankara, Turkey; Ankara University Brain Research Center, Ankara, Turkey
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Mora-Munoz L, Alsheikhtaha Z, Foldvary-Schaefer N. Differential Diagnosis of Complex Nocturnal Behaviors. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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9
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Havis I, Coates T, Wyant KJ, Spears CC, Garwood M, Kotagal V. Isolated REM sleep behavior disorder in North American older adults in an integrated health care system. J Clin Sleep Med 2022; 18:2173-2178. [PMID: 35678069 PMCID: PMC9435338 DOI: 10.5664/jcsm.10066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE Identifying individuals with isolated rapid eye movement sleep behavioral disorder (iRBD) is an important clinical research priority for future synucleinopathy trials. Nevertheless, little is known about the breadth of clinical settings where diagnoses of iRBD are initially made. METHODS We conducted a retrospective cohort study using the electronic medical record system at the University of Michigan to identify patients aged ≥ 60 years with new diagnoses of iRBD between 2015 and 2020. We focused specifically on patients receiving primary care at the University of Michigan so that we might use the university's electronic medical record system to capture the full scope of their multispecialty care interactions and diagnoses in this integrated health care system. We used International Classification of Diseases, Ninth Revision and Tenth Revision, diagnosis codes to identify the time of initial clinical diagnosis. RESULTS We found that 62/105 (59.0%) diagnoses were made by a sleep specialist, 9 (8.6%) by neurologists, and 30 (29.5%) by generalists or primary care (29.5%) providers. In addition, 67/105 (63.8%) diagnoses were made in the context of having available polysomnography results, while the remainder was made on the basis of clinical symptoms alone. The prognostic implications of iRBD were documented in 40/105 (38.1%) encounter notes and were more likely to occur in sleep clinic settings (chi-square = 12.74; P < .001) than in other contexts. CONCLUSIONS Initial iRBD diagnoses occur in varied clinical settings in an integrated health care system and are often made without a confirmatory polysomnogram. Documented prognostic counseling is seen most often in sleep medicine clinics. Synucleinopathy prevention trials may be best designed around a sleep clinic-focused recruitment approach. CITATION Havis I, Coates T, Wyant KJ, Spears CC, Garwood M, Kotagal V. Isolated REM sleep behavior disorder in North American older adults in an integrated health care system. J Clin Sleep Med. 2022;18(9):2173-2178.
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Affiliation(s)
- Isabelle Havis
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Trinity Coates
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Kara J. Wyant
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | | | - Mark Garwood
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Ann Arbor Healthcare System and Veterans Affairs Ann Arbor Healthcare System Geriatric Research Education and Clinical Center, Ann Arbor, Michigan
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10
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Schenck CH. REM sleep behavior disorder as a complex condition with heterogeneous underlying disorders: clinical management and prognostic implications [Commentary]. Sleep Breath 2022; 26:1289-1298. [PMID: 35239134 DOI: 10.1007/s11325-022-02574-6] [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: 01/26/2022] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To review how REM sleep behavior disorder (RBD) is a complex condition with heterogeneous underlying disorders; and to review clinical management issues and prognostic implications. METHODS PubMed literature search and contents from the first textbook of RBD (2018). RESULTS RBD, with its core objective diagnostic feature of REM-without-atonia (RWA) documented by video-polysomnography, can emerge during the entire lifespan, and can initially present as an idiopathic (isolated) condition (iRBD), or can be associated with a broad spectrum of disorders including narcolepsy, alpha-synuclein neurodegenerative disorders (esp. Parkinson's disease [PD] and dementia with Lewy bodies [DLB]), paraneoplastic neurological syndromes and autoimmune disorders, CNS lesions (e.g., tumors, stroke), other neurological disorders, psychiatric disorders (PTSD, mood disorders), can be triggered by antidepressant/other medications, and can emerge acutely with drug withdrawal states, toxic-metabolic states, etc. Important clinical issues include the evolution of iRBD to PD/DLB in most middle-aged and older patients over a period of years to several decades, with compelling prognostic implications, along with the hope of enrolling these patients in future clinical trials to test promising disease-modifying therapies. Also, the strong link of RBD with narcolepsy needs further investigation. Parasomnia overlap disorder involves RBD and NREM parasomnias that can be idiopathic or linked with a broad range of clinical disorders. RBD usually responds to therapy consisting mainly of melatonin and/or clonazepam at bedtime. The complex associations of RBD with OSA are being increasingly investigated. RBD mimics with dream-enactment need to be recognized for diagnostic and management purposes, including severe OSA, NREM parasomnias, PLMD, nocturnal seizures, and other conditions. CONCLUSIONS The clinical and research RBD fields span across the disciplines of neurology, pulmonary, psychiatry, psychology, and pediatric sleep medicine, along with physical medicine and rehabilitation medicine, other allied disciplines, and the basic and clinical neurosciences.
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Affiliation(s)
- Carlos H Schenck
- Minnesota Regional Sleep Disorders Center and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA.
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11
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Högl B, Arnulf I, Bergmann M, Cesari M, Gan-Or Z, Heidbreder A, Iranzo A, Krohn L, Luppi PH, Mollenhauer B, Provini F, Santamaria J, Trenkwalder C, Videnovic A, Stefani A. Rapid eye movement sleep behaviour disorder: Past, present, and future. J Sleep Res 2022; 31:e13612. [PMID: 35470494 PMCID: PMC9541438 DOI: 10.1111/jsr.13612] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
This manuscript presents an overview of REM sleep behaviour disorder (RBD) with a special focus on European contributions. After an introduction examining the history of the disorder, we address the pathophysiological and clinical aspects, as well as the diagnostic issues. Further, implications of RBD diagnosis and biomarkers are discussed. Contributions of European researchers to this field are highlighted.
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Affiliation(s)
- Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France.,Faculty of Medicine, Sorbonne University, Paris, France
| | - Melanie Bergmann
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Ziv Gan-Or
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada.,Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Anna Heidbreder
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Alex Iranzo
- Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, University of Barcelona, Barcelona, Spain
| | - Lynne Krohn
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada.,Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Pierre-Hervé Luppi
- Centre of Neuroscience of Lyon, UMR 5292 CNRS/U1028 INSERM, Lyon, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Federica Provini
- IRCCS Institute of Neurological Sciences, UOC NeuroMet, Bellaria Hospital, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joan Santamaria
- Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, University of Barcelona, Barcelona, Spain
| | - Claudia Trenkwalder
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ambra Stefani
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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12
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Schaeffer E, Toedt I, Köhler S, Rogge A, Berg D. Risk Disclosure in Prodromal Parkinson's Disease. Mov Disord 2021; 36:2833-2839. [PMID: 34351002 DOI: 10.1002/mds.28723] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Impressive progress in the understanding of the prodromal phase of Parkinson's disease (PD) in recent years has enabled the generation of disease prediction models. However, a remaining diagnostic uncertainty and lack of therapeutic options for affected individuals has resulted in a variety of ethical issues that have not to date been addressed sufficiently. Moreover, differences in the specificity of prodromal symptoms and possible subtypes of PD, especially the presence of rapid eye movement (REM) sleep behavior disorder (RBD), may have an important impact on prognostic counseling. OBJECTIVES To derive a guideline for risk disclosure in prodromal PD based on the current literature and expert opinion. METHODS We performed (1) a literature review on prognostic counseling in PD and (2) consulted with international experts on prodromal PD using a semi-structured questionnaire based on a Delphi approach to evaluate recommendations for risk disclosure in PD. RESULTS The literature research revealed only 11 publications addressing prognostic counseling, with only two studies directly addressing affected individuals and most studies focusing on risk disclosure in RBD. The expert survey revealed the importance of distinguishing between individuals with and without RBD in prognostic counseling. CONCLUSIONS Based on the current literature and expert recommendations, a guideline for risk disclosure in prodromal PD for clinical care and research could be elaborated. Prognostic counseling should include differentiation between individuals with and without RBD, taking into account the high uncertainty of risk calculation in RBD-negative prodromal PD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Eva Schaeffer
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Inken Toedt
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Susanne Köhler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Annette Rogge
- Institute of Experimental Medicine, Medical Ethics, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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13
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REM Sleep Behavior Disorder as a Pathway to Dementia: If, When, How, What, and Why Should Physicians Disclose the Diagnosis and Risk for Dementia. CURRENT SLEEP MEDICINE REPORTS 2021; 7:57-64. [PMID: 34336551 PMCID: PMC8302466 DOI: 10.1007/s40675-021-00206-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/02/2022]
Abstract
Purpose of Review People with isolated REM (rapid eye movement) sleep behavior disorder (iRBD) have a high lifetime risk of developing a neurodegenerative disease, including dementia, but disclosure of this risk remains controversial. Herein, we summarize this controversy and provide guidance on disclosure. Recent Findings Neurodegeneration risk disclosure in iRBD is controversial because of a long latency to disease onset and a lack of preventative strategies. Balancing the relevant ethical principles of beneficence, nonmaleficence, and autonomy is challenging. Although there are few data on disclosure in iRBD, evidence from discussing risk in other diseases with dementia provides some guidance. Summary We provide an approach to risk disclosure for patients with iRBD. Patients should be asked if they want to know about future risks. If so, disclosure should be patient centered, focusing on what might happen. Discussion should occur early to give patients time to prepare for the future and consider participating in research.
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14
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Teigen LN, Sharp RR, Hirsch JR, Campbell E, Timm PC, Sandness DJ, Feemster JC, Gossard TR, Faber SM, Steele TA, Rivera S, Junna MR, Lipford MC, Tippmann-Peikert M, Kotagal S, Ju YE, Howell M, Schenck CH, Videnovic A, Jennum P, Hogl B, Stefani A, Arnulf I, Heidbreder A, Lewis S, McCarter SJ, Boeve BF, Silber MH, St Louis EK. Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder. Sleep Med 2020; 79:107-112. [PMID: 33486257 PMCID: PMC10075000 DOI: 10.1016/j.sleep.2020.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES/BACKGROUND Most middle-aged and older adult patients with isolated (idiopathic) REM sleep behavior disorder (RBD) eventually develop parkinsonism, dementia with Lewy bodies, or multiple system atrophy. We aimed to describe the current sleep medicine specialist approach toward RBD prognostic counseling, and to determine physician beliefs and characteristics that impact provision of counseling. PATIENTS/METHODS We surveyed 70 sleep medicine physicians with RBD expertise for demographic information, counseling practices, and their beliefs and understandings concerning the association between RBD and synucleinopathies, among other questions. Responses were summarized by descriptive statistics. RESULTS Among the 44 respondents (63% response rate), 41 (93.2%) regularly provided prognostic counseling for most RBD patients, but only 31.8% routinely asked about patient preferences on receiving counseling. 41.8% believed that the risk for developing overt synucleinopathy following RBD diagnosis was >80%, but only 15.9% routinely provided this detailed phenoconversion risk estimate to their patients. Most respondents were concerned that RBD prognostic counseling could adversely impact on the patient's and family's mental health. CONCLUSIONS Most expert RBD sleep clinicians routinely counsel their patients regarding the high risk for phenoconversion to parkinsonism or dementia, yet relatively few routinely ask patients about their preferences for receiving this information, and fewer provide details concerning the known high risk estimates for developing a synucleinopathy. Future research should analyze patients' values and preferences in RBD populations to inform approaches toward shared decision making for RBD prognostic counseling.
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Affiliation(s)
- Luke N Teigen
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jessica R Hirsch
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Emmaling Campbell
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; University of South Carolina, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David J Sandness
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Thomas R Gossard
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sarah M Faber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tyler A Steele
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; University of Minnesota-Rochester, Rochester, MN, USA
| | - Sonia Rivera
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; University of Minnesota-Rochester, Rochester, MN, USA
| | - Mithri R Junna
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Maja Tippmann-Peikert
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Suresh Kotagal
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Yo-El Ju
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Michael Howell
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, And Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Poul Jennum
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Hogl
- Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Isabelle Arnulf
- Pitie Salpetriere Hopital and Sorbonne University, Paris, France
| | - Anna Heidbreder
- Department of Neurology, University of Innsbruck, Innsbruck, Austria; Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Simon Lewis
- Department of Neurology, University of Sidney, Sidney, Australia
| | - Stuart J McCarter
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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15
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Dommershuijsen LJ, Darweesh SKL, Luik AI, Kieboom BCT, Koudstaal PJ, Boon AJW, Ikram MA, Ikram MK, Bunnik EM. Ethical Considerations in Screening for Rapid Eye Movement Sleep Behavior Disorder in the General Population. Mov Disord 2020; 35:1939-1944. [PMID: 32930445 DOI: 10.1002/mds.28262] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/11/2020] [Indexed: 11/09/2022] Open
Abstract
Clinical studies have shown that up to 90% of patients with idiopathic rapid eye movement sleep behavior disorder (RBD) will eventually be diagnosed with a clinical α-synucleinopathy. Because of this high conversion rate, screening for RBD is often performed to identify eligible participants for studies aimed at elucidating the prodromal phase of α-synucleinopathies. However, screening for RBD, especially in the general population, raises many ethical dilemmas. In light of the existing ethical literature and our experience in establishing a screening approach for RBD in the Rotterdam Study, we discuss ethical dilemmas when screening for RBD in population-based studies. We conclude that informing study participants about the reason for invitation and the possible trajectory that lies ahead when participating is essential. However, participants should not be troubled unnecessarily by giving them detailed information about possible diagnoses or associated disease risks. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lisanne J Dommershuijsen
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Brenda C T Kieboom
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Agnita J W Boon
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eline M Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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16
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Videnovic A, Ju YES, Arnulf I, Cochen-De Cock V, Högl B, Kunz D, Provini F, Ratti PL, Schiess MC, Schenck CH, Trenkwalder C. Clinical trials in REM sleep behavioural disorder: challenges and opportunities. J Neurol Neurosurg Psychiatry 2020; 91:740-749. [PMID: 32404379 PMCID: PMC7735522 DOI: 10.1136/jnnp-2020-322875] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/31/2020] [Accepted: 04/17/2020] [Indexed: 01/13/2023]
Abstract
The rapid eye movement sleep behavioural disorder (RBD) population is an ideal study population for testing disease-modifying treatments for synucleinopathies, since RBD represents an early prodromal stage of synucleinopathy when neuropathology may be more responsive to treatment. While clonazepam and melatonin are most commonly used as symptomatic treatments for RBD, clinical trials of symptomatic treatments are also needed to identify evidence-based treatments. A comprehensive framework for both disease-modifying and symptomatic treatment trials in RBD is described, including potential treatments in the pipeline, cost-effective participant recruitment and selection, study design, outcomes and dissemination of results. For disease-modifying treatment clinical trials, the recommended primary outcome is phenoconversion to an overt synucleinopathy, and stratification features should be used to select a study population at high risk of phenoconversion, to enable more rapid clinical trials. For symptomatic treatment clinical trials, objective polysomnogram-based measurement of RBD-related movements and vocalisations should be the primary outcome measure, rather than subjective scales or diaries. Mobile technology to enable objective measurement of RBD episodes in the ambulatory setting, and advances in imaging, biofluid, tissue, and neurophysiological biomarkers of synucleinopathies, will enable more efficient clinical trials but are still in development. Increasing awareness of RBD among the general public and medical community coupled with timely diagnosis of these diseases will facilitate progress in the development of therapeutics for RBD and associated neurodegenerative disorders.
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Affiliation(s)
- Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yo-El S Ju
- Department of Neurology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Isabelle Arnulf
- Assistance Publique Hôpitaux de Paris, Service des pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France.,UMR S 1127, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC University Paris, Paris, France
| | - Valérie Cochen-De Cock
- Neurologie et sommeil, Clinique Beau Soleil, Montpellier, France.,Laboratoire Movement to Health (M2H), EuroMov, Université Montpellier, Montpellier, France
| | - Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Dieter Kunz
- Clinic for Sleep and Chronomedicine, Berlin, Germany
| | - Federica Provini
- IRCCS Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Mya C Schiess
- Department of Neurology, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Carlos H Schenck
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.,Minnesota Regional Sleep Disorders Center, Minneapolis, Minnesota, USA
| | - Claudia Trenkwalder
- Paracelsus Elena Klinik, Kassel, Germany.,Department of Neurosurgery, University Medical Center, Göttingen, Germany
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17
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St Louis EK. Prognostic Counseling for Patients With Idiopathic/Isolated REM Sleep Behavior Disorder: Should We Tell Them What's Coming? Yes. Mov Disord Clin Pract 2019; 6:667-668. [PMID: 31745475 DOI: 10.1002/mdc3.12814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Erik K St Louis
- Mayo Center for Sleep Medicine, and Sleep Behavior and Neurophysiology Laboratory, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester Minnesota USA
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