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Xie WY, Duan WX, Chen Y, Tao MX, Li HX, Gao F, Yin JY, Yan JH, Wang F, Mao CJ, Shen Y, Liu CF. The impact of bright light therapy on Parkinson's disease: A pilot study using vestibular-evoked myogenic potentials. Parkinsonism Relat Disord 2025; 134:107776. [PMID: 40090131 DOI: 10.1016/j.parkreldis.2025.107776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/27/2025] [Accepted: 03/09/2025] [Indexed: 03/18/2025]
Abstract
INTRODUCTION Bright light therapy (BLT) has been proved to have beneficial effects on Parkinson's disease (PD). Brainstem pathways improvements might be crucial to BLT, but the mechanisms remained unclear. The aim of this study is to validate whether BLT improves clinical symptoms in PD and thus explore the possible mechanisms of brainstem pathways evaluated by vestibular-evoked myogenic potentials (VEMPs). METHODS A total of 22 PD patients participated were enrolled in this crossover randomized placebo-controlled study. Participants received either one month of BLT or dim light therapy (DLT), separated by a 1-month wash-out period, and underwent clinical scales and VEMPs evaluations before and after each intervention. Mixed-effects regression models were used to determine the effect between BLT and DLT on PD patients by the differentials of clinical scales (Δscales) and VEMPs (ΔVEMPs). Correlations between the improvement of clinical symptoms and VEMPs parameters improvements were analyzed in PD patients receiving BLT. RESULTS Excessive daytime sleepiness, anxiety, life quality and autonomic function were improved after BLT. Compared to DLT, the difference was not significant. There were significant differences of cervical VEMPs (cVEMP) and ocular VEMPs (oVEMP) peak latencies after BLT. Compared with DLT, there was significant difference in ΔLp13, ΔRp13 and ΔLp11 peak latencies after BLT. CONCLUSIONS BLT may be a valuable non-pharmacological intervention for improving brainstem function, thereby enhancing quality of life and overall health in PD patients.
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Affiliation(s)
- Wei-Ye Xie
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Wen-Xiang Duan
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Ying Chen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Meng-Xing Tao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Han-Xing Li
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Fan Gao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Jie-Yun Yin
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases, Soochow University, Suzhou, 215123, China
| | - Jia-Hui Yan
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Fen Wang
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, 215123, China
| | - Cheng-Jie Mao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Yun Shen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, 215123, China; Department of Neurology, Xiongan Xuanwu Hospital, Xiongan, 071700, China.
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Li X, Du X, Zhao R, Du H, Zhao L. Association between vestibular evoked myogenic potentials and different dizziness status in Parkinson's disease: A controlled study. Clin Neurol Neurosurg 2025; 249:108711. [PMID: 39729788 DOI: 10.1016/j.clineuro.2024.108711] [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: 09/11/2024] [Revised: 12/04/2024] [Accepted: 12/23/2024] [Indexed: 12/29/2024]
Abstract
OBJECTIVE This study compared ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP) among individuals with Parkinson's disease (PD) without dizziness, with nonspecific dizziness (dizziness without orthostatic hypotension), or with dizziness combined with orthostatic hypotension. MATERIALS AND METHODS We prospectively analyzed 30 of each of the three types of individuals who were admitted to Yongchuan Hospital of Chongqing Medical University (Chongqing, China) between June 2022 and April 2023. The three groups received oVEMP and cVEMP measurements using an electromyography-evoked potential system. For oVEMP, the N10 latency, P16 latency, and amplitude were compared between the three groups and the reference values. For cVEMP, the P13 latency, N23 latency, and amplitude were compared between the three groups and the reference values. Overall characteristics of oVEMP and cVEMP were also assessed using a previously published scoring scale originally developed for individuals with multiple sclerosis between the three groups included. The correlation between VEMP parameters (the latency and amplitude) and VEMP scores were simultaneously analyzed using Pearson's bivariate correlation analysis. RESULTS When compared with reference values, the oVEMP and cVEMP parameters of all three groups were found to be slightly different from the reference values. When the three groups included were compared with each other, in terms of oVEMP, the average amplitude in the left eye was significantly higher in those with nonspecific dizziness than in the other two groups. In terms of cVEMP, the average N23 latency on both the right and left sides of the neck and average amplitude on the right side of the neck were significantly higher in those with nonspecific dizziness than in the other two groups. Scores for oVEMP and cVEMP were also significantly higher for those with nonspecific dizziness than for the other two groups. There were no significant differences in oVEMP and cVEMP parameters, and scores for oVEMP and cVEMP between patients with dizziness combined with orthostatic hypotension and those without dizziness. In terms of correlation analysis, the N23 latency of left neck (r = 0.509, p < 0.001), the N23 latency of right neck (r = 0.495, p < 0.001), and the amplitude of right neck (r = 0.304, p = 0.004) correlated positively with cVEMP score. CONCLUSIONS Patients with PD without dizziness, with dizziness attributable to orthostatic hypotension, and with nonspecific dizziness may be all associated with vestibular dysfunction. The VEMP scores were highest in patients with nonspecific dizziness, so vestibular function is more severely affected in patients with nonspecific dizziness. The VEMP especially cVEMP may be useful for early diagnosis of nonspecific dizziness in PD.
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Affiliation(s)
- Xingyue Li
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China; Chongqing Key Laboratory of Cerebrovascular Disease Research, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China; Department of Encephalopathy, Yongchuan District Hospital of Traditional Chinese Medicine, 2# Yingbin Avenue, Yongchuan, Chongqing 402160, China
| | - Xiaoyan Du
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China; Chongqing Key Laboratory of Cerebrovascular Disease Research, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China
| | - Rui Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China; Chongqing Key Laboratory of Cerebrovascular Disease Research, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China
| | - Hongheng Du
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China; Chongqing Key Laboratory of Cerebrovascular Disease Research, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China
| | - Libo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China; Chongqing Key Laboratory of Cerebrovascular Disease Research, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China.
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Tas Elibol N, Behmen MB, Terlemez Ş, Konukseven Ö. Evaluation of Masseteric Vestibular Evoked Myogenic Potentials in Patients With Migraine. Am J Audiol 2024; 33:510-517. [PMID: 38635409 DOI: 10.1044/2024_aja-23-00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Masseter vestibular evoked myogenic potentials (mVEMP) involve the connection between the vestibular complex and trigeminal nerve nuclei. Given the theory that migraine is caused by increased activation of the trigeminal nerve, it is believed that mVEMP responses may have influenced in migraine patients. METHOD The study included 20 individuals with migraine and 20 healthy controls. Latency, amplitude, and interaural amplitude asymmetry ratio of mVEMP responses recorded in migraine patients were compared with control group. RESULTS Considering the mVEMP normalization study conducted by Başöz et al. (2021) in a similar age group and in the same clinic, latency prolongation and amplitude decrease were observed in subjects with migraines. Migraine is considered a central pathology, as shown in the cervical and ocular VEMP (cVEMP/oVEMP) literature. No difference was observed in the interaural amplitude asymmetry ratio, which is important in peripheral pathologies. Additionally, when the number of pathological ears was examined in order to understand the total exposure, it was observed that the number of pathological ears was significantly higher in the migraine group. CONCLUSION In future studies, using mVEMP together with cVEMP and oVEMP tests, which allow evaluation of otolith organs and vestibular nuclei, will be valuable in determining the lesion location. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25607901.
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Affiliation(s)
- Nida Tas Elibol
- Faculty of Health Sciences, Department of Audiology, Bezmialem Vakif University, İstanbul, Turkey
| | - Meliha Başöz Behmen
- Faculty of Health Sciences, Department of Audiology, Bezmialem Vakif University, İstanbul, Turkey
| | - Şengül Terlemez
- Institute of Health Sciences, Department of Audiology, İstanbul Aydin University, İstanbul, Turkey
| | - Özlem Konukseven
- Institute of Health Sciences, Department of Audiology, İstanbul Aydin University, İstanbul, Turkey
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Bergmann M, Högl B, Stefani A. Clinical neurophysiology of REM parasomnias: Diagnostic aspects and insights into pathophysiology. Clin Neurophysiol Pract 2024; 9:53-62. [PMID: 38328386 PMCID: PMC10847011 DOI: 10.1016/j.cnp.2023.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/17/2023] [Accepted: 10/22/2023] [Indexed: 02/09/2024] Open
Abstract
Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep related behaviors, perceptions, emotions, dreams, and autonomic nervous system activity. Rapid eye movement (REM) parasomnias include REM sleep behavior disorder (RBD), isolated recurrent sleep paralysis and nightmare disorder. Neurophysiology is key for diagnosing these disorders and provides insights into their pathophysiology. RBD is very well characterized from a neurophysiological point of view, also thank to the fact that polysomnography is needed for the diagnosis. Diagnostic criteria are provided by the American Academy of Sleep Medicine and video-polysomnography guidelines for the diagnosis by the International REM Sleep Behavior Disorder Study Group. Differences between the two sets of criteria are presented and discussed. Availability of polysomnography in RBD provides data on sleep electroencephalography (EEG), electrooculography (EOG) and electromyography (EMG). Sleep EEG in RBD shows e.g. changes in delta and theta power, in sleep spindles and K complexes. EMG during REM sleep is essential for RBD diagnosis and is an important neurodegeneration biomarker. RBD patients present alterations also in wake EEG, autonomic function, evoked potentials, and transcranial magnetic stimulation. Clinical neurophysiological data on recurrent isolated sleep paralysis and nightmare disorder are scant. The few available data provide insights into the pathophysiology of these disorders, demonstrating a state dissociation in recurrent isolated sleep paralysis and suggesting alterations in sleep macro- and microstructure as well as autonomic changes in nightmare disorder.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, USA
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Nagarajan A, Sinha SK. Masseter Vestibular evoked myogenic potentials: A new tool to assess the vestibulomasseteric reflex pathway. J Otol 2024; 19:46-54. [PMID: 38313757 PMCID: PMC10837556 DOI: 10.1016/j.joto.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose This review article provides the readers with an in-depth insight in understanding and interpreting various research literatures on the masseter vestibular evoked myogenic potentials (mVEMP). The article also reviews the contemporary researches involving the clinical applications of the mVEMP. Conclusions Masseter VEMP is an evolving yet clinically promising neuro-otology test tool that has recently gained more research interest and is considered an additional tool to diagnose various vestibular disorders. Masseter VEMP assesses the functional integrity of the acoustic-masseteric and vestibulo-masseteric reflex pathways. The mVEMP could be used as a complementary test to evaluate the same peripheral generator as the cervical VEMP but a different central pathway i.e., vestibulo-trigeminal pathway. Various research studies that have experimented on parameters such as the effect of different electrode montages (zygomatic vs mandibular configurations), stimulation rates, filter settings and stimuli used to evoke mVEMP have been discussed in this article that could assist in the optimization of a comprehensive clinical protocol. The latency and the amplitude of mVEMP waveforms serve as significant parameters in differentiating normals from those of the clinical populations. Along with the cVEMPs and oVEMPs, mVEMP might help diagnose brainstem lesions in REM Sleep behaviour disorders, Multiple Sclerosis and Parkinson's disease. However, further studies are required to probe in this area of research.
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Figorilli M, Meloni F, Lecca R, Tamburrino L, Mascia MG, Cocco V, Meloni M, Marques AR, Vidal T, Congiu P, Defazio G, Durif F, Lanza G, Ferri R, Schenck CH, Fantini ML, Puligheddu M. Severity of REM sleep without atonia correlates with measures of cognitive impairment and depressive symptoms in REM sleep behaviour disorder. J Sleep Res 2023; 32:e13880. [PMID: 36998161 DOI: 10.1111/jsr.13880] [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: 01/12/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
This study aimed to correlate REM sleep without atonia (RSWA) and neuropsychological data in patients with idiopathic/isolated REM sleep behaviour disorder (iRBD) and those with RBD associated with Parkinson's disease (PDRBD), in order to assess whether higher degrees of RSWA are related to poorer cognitive performance. A total of 142 subjects were enrolled: 48 with iRBD, 55 with PDRBD, and 39 PD without RBD (PDnoRBD). All participants underwent video-polysomnographic recording, clinical and neuropsychological assessment. RSWA was quantified according to two manual scoring methods (Montréal, SINBAR) and one automated (REM atonia index, RAI). Mild cognitive impairment (MCI) was diagnosed according to diagnostic criteria for MCI in Parkinson's disease. The relationship between neuropsychological scores and RSWA metrics was explored by multiple linear regression analysis and logistic regression models. Patients with iRBD showed significantly lower visuospatial functions and working memory, compared with the others. More severe RSWA was associated with a higher risk of reduced visuospatial abilities (OR 0.15), working memory (OR 2.48), attention (OR 2.53), and semantic fluency (OR 0.15) in the iRBD. In the whole group, a greater RSWA was associated with an increased risk for depressive symptoms (OR 3.6). A total of 57(40%) MCI subjects were found (17 iRBD, 26 PDRBD, and 14 PDnoRBD). Preserved REM-atonia was associated with a reduced odds of multi-domain MCI in the whole study population (OR 0.54). In conclusion, a greater severity of RSWA was associated with an increased risk for poor cognitive performance and depressive mood in patients with RBD. Moreover, higher RAI was associated with a lower risk of multi-domain MCI.
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Affiliation(s)
- Michela Figorilli
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | - Federico Meloni
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Viola Cocco
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Meloni
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Ana Raquel Marques
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Tiphaine Vidal
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Patrizia Congiu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | - Frank Durif
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Giuseppe Lanza
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maria Livia Fantini
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
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Du L, He X, Fan X, Wei X, Xu L, Liang T, Wang C, Ke Y, Yung WH. Pharmacological interventions targeting α-synuclein aggregation triggered REM sleep behavior disorder and early development of Parkinson's disease. Pharmacol Ther 2023; 249:108498. [PMID: 37499913 DOI: 10.1016/j.pharmthera.2023.108498] [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: 04/28/2023] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by elevated motor behaviors and dream enactments in REM sleep, often preceding the diagnosis of Parkinson's disease (PD). As RBD could serve as a biomarker for early PD developments, pharmacological interventions targeting α-synuclein aggregation triggered RBD could be applied toward early PD progression. However, robust therapeutic guidelines toward PD-induced RBD are lacking, owing in part to a historical paucity of effective treatments and trials. We reviewed the bidirectional links between α-synuclein neurodegeneration, progressive sleep disorders, and RBD. We highlighted the correlation between RBD development, α-synuclein aggregation, and neuronal apoptosis in key brainstem regions involved in REM sleep atonia maintenance. The current pharmacological intervention strategies targeting RBD and their effects on progressive PD are discussed, as well as current treatments for progressive neurodegeneration and their effects on RBD. We also evaluated emerging and potential pharmacological solutions to sleep disorders and developing synucleinopathies. This review provides insights into the mechanisms and therapeutic targets underlying RBD and PD, and explores bidirectional treatment effects for both diseases, underscoring the need for further research in this area.
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Affiliation(s)
- Lida Du
- Institute of Molecular Medicine & Innovative Pharmaceutics, Qingdao University, Qingdao, China; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Xiaoli He
- Institute of Medical Plant Development, Peking Union Medical College, Beijing, China
| | - Xiaonuo Fan
- Department of Biology, Boston University, Boston, USA
| | - Xiaoya Wei
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Linhao Xu
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tuo Liang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Institute of Neurological and Psychiatric Disorders, Shenzhen Bay Laboratory, Shenzhen, China
| | - Chunbo Wang
- Institute of Molecular Medicine & Innovative Pharmaceutics, Qingdao University, Qingdao, China
| | - Ya Ke
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Ho Yung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Neuroscience, City University of Hong Kong, Hong Kong, China.
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Figorilli M, Meloni M, Lanza G, Casaglia E, Lecca R, Saibene FL, Congiu P, Puligheddu M. Considering REM Sleep Behavior Disorder in the Management of Parkinson's Disease. Nat Sci Sleep 2023; 15:333-352. [PMID: 37180094 PMCID: PMC10167974 DOI: 10.2147/nss.s266071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is the result of the loss of physiological inhibition of muscle tone during REM sleep, characterized by dream-enacting behavior and widely recognized as a prodromal manifestation of alpha-synucleinopathies. Indeed, patients with isolated RBD (iRBD) have an extremely high estimated risk to develop a neurodegenerative disease after a long follow up. Nevertheless, in comparison with PD patients without RBD (PDnoRBD), the occurrence of RBD in the context of PD (PDRBD) seems to identify a unique, more malignant phenotype, characterized by a more severe burden of disease in terms of both motor and non-motor symptoms and increased risk for cognitive decline. However, while some medications (eg, melatonin, clonazepam, etc.) and non-pharmacological options have been found to have some therapeutic benefits on RBD there is no available treatment able to modify the disease course or, at least, slow down the neurodegenerative process underlying phenoconversion. In this scenario, the long prodromal phase may allow an early therapeutic window and, therefore, the identification of multimodal biomarkers of disease onset and progression is becoming increasingly crucial. To date, several clinical (motor, cognitive, olfactory, visual, and autonomic features) neurophysiological, neuroimaging, biological (biofluids or tissue biopsy), and genetic biomarkers have been identified and proposed, also in combination, as possible diagnostic or prognostic markers, along with a potential role for some of them as outcome measures and index of treatment response. In this review, we provide an insight into the present knowledge on both existing and future biomarkers of iRBD and highlight the difference with PDRBD and PDnoRBD, including currently available treatment options.
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Affiliation(s)
- Michela Figorilli
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Meloni
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Elisa Casaglia
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Patrizia Congiu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Quantification of REM sleep without atonia: A review of study methods and meta-analysis of their performance for the diagnosis of RBD. Sleep Med Rev 2023; 68:101745. [PMID: 36640617 DOI: 10.1016/j.smrv.2023.101745] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The present review focuses on REM sleep without atonia (RSWA) scoring methods. In consideration of the numerous papers published in the last decade, that used different methods for the quantification of RSWA, their systematic revision is an emerging need. We made a search using the PubMed, Embase, Scopus and Web of Science Databases, from 2010 until December 2021, combining the search term "RSWA" with "scoring methods", "IRBD", "alfasyn disease", and "neurodegenerative disease", and with each of the specific sleep disorders, diagnosed according to current criteria, with the identification of the references of interest for the topic. Furthermore, a Meta-analysis of the diagnostic performance of RSWA scoring methods, in terms of sensitivity and specificity, was carried out. The comparison of the hierarchical summary receiver-operating characteristic curves obtained for visual methods and that obtained for the automated REM sleep atonia index (RAI), shows substantially similar prediction areas indicating a comparable performance. This systematic review and meta-analysis support the validity of a series of visual methods and of the automated RAI in the quantification of RSWA with the purpose to guide clinicians in the interpretation of their results and their correct and efficient use within the diagnostic work-up for REM sleep behavior disorder.
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Assessment of Vestibular-Evoked Myogenic Potentials in Parkinson’s Disease: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12070956. [PMID: 35884762 PMCID: PMC9313211 DOI: 10.3390/brainsci12070956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/03/2022] [Accepted: 07/19/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The brainstem plays an essential role in the early stage of Parkinson’s disease (PD), but it is not widely tested in clinical examinations of PD. Vestibular-evoked myogenic potentials (VEMPs) are recognized as fundamental tools in the assessment of brainstem function. The aim of our meta-analysis was to assess the abnormal findings of VEMPs in patients with PD. (2) Methods: Up to 14 February 2022, PubMed, Embase, and Web of Science were searched to evaluate VEMPs in patients with PD in comparison with respective controls. The study protocol was registered at PROSPERO (CRD42022311103). (3) Results: A total of 15 studies were finally included in our meta-analysis. The absence rates of VEMPs in patients with PD were significantly higher than those of control groups (cVEMP: OR = 6.77; oVEMP: OR = 13.9; mVEMP: OR = 7.52). A delayed P13 latency, a decreased peak-to-peak amplitude, and an increased AAR of cVEMP, and a delayed oVEMP P15 latency were also found in patients with PD. (4) Conclusions: Our meta-analysis indicates abnormal VEMP findings in patients with PD, revealing the dysfunction of the brainstem in PD. VEMP tests, especially cVEMP tests, could be a helpful method for the early detection of PD.
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