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Bergmann M, Stefani A, Ibrahim A, Anselmi V, Brandauer E, Högl B, Cesari M. A 24% prevalence of excessive fragmentary myoclonus in 500 consecutive sleep laboratory patients. J Sleep Res 2024; 33:e14074. [PMID: 37922734 DOI: 10.1111/jsr.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Excessive fragmentary myoclonus (EFM) is a frequent finding during routine video-polysomnography (VPSG). We aimed to automatically measure the prevalence of EFM according to current American Academy of Sleep Medicine (AASM) criteria, and the fragmentary myoclonus index (FMI) in sleep stage N1, N2, N3, rapid eye movement (REM) sleep and wake in a large patient population. A total of 500 VPSG recordings of patients admitted to the Sleep Laboratory, Department of Neurology, Medical University of Innsbruck, Austria, between May 1, 2022 and February 28, 2023, were included. EFM according to AASM criteria and FMI were computed by applying a previously validated algorithm. EFM was automatically detected in 121 of the 500 Sleep Laboratory patients (24.2%, 95% confidence interval 20.1%-28.9%). FMI increased with age, male gender, apnea-hypopnea-index (AHI), oxygen desaturation index (ODI), and periodic leg movements of sleep (PLMS) index. FMI was highest in REM sleep behaviour disorder (RBD), followed by neurodegenerative and internal medicine diseases, but the increase in the FMI was not explained by the disease itself but rather by the age and sex of the patients. Almost a quarter of our patient population had EFM. However, the prevalence of EFM does not allow the drawing of any conclusions about the pathophysiology of EFM or even the determination of a pathological FMI cut-off value. Associations of the FMI with age, sex, AHI, ODI and PLMS are in line with previous studies, but the FMI needs to be evaluated in different disease entities to learn more about its pathophysiology.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Victoria Anselmi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Grander M, Haschka D, Indelicato E, Kremser C, Amprosi M, Nachbauer W, Henninger B, Stefani A, Högl B, Fischer C, Seifert M, Kiechl S, Weiss G, Boesch S. Genetic Determined Iron Starvation Signature in Friedreich's Ataxia. Mov Disord 2024. [PMID: 38686449 DOI: 10.1002/mds.29819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Early studies in cellular models suggested an iron accumulation in Friedreich's ataxia (FA), yet findings from patients are lacking. OBJECTIVES The objective is to characterize systemic iron metabolism, body iron storages, and intracellular iron regulation in FA patients. METHODS In FA patients and matched healthy controls, we assessed serum iron parameters, regulatory hormones as well as the expression of regulatory proteins and iron distribution in peripheral blood mononuclear cells (PBMCs). We applied magnetic resonance imaging with R2*-relaxometry to quantify iron storages in the liver, spleen, and pancreas. Across all evaluations, we assessed the influence of the genetic severity as expressed by the length of the shorter GAA-expansion (GAA1). RESULTS We recruited 40 FA patients (19 women). Compared to controls, FA patients displayed lower serum iron and transferrin saturation. Serum ferritin, hepcidin, mean corpuscular hemoglobin and mean corpuscular volume in FA inversely correlated with the GAA1-repeat length, indicating iron deficiency and restricted availability for erythropoiesis with increasing genetic severity. R2*-relaxometry revealed a reduction of splenic and hepatic iron stores in FA. Liver and spleen R2* values inversely correlated with the GAA1-repeat length. FA PBMCs displayed downregulation of ferritin and upregulation of transferrin receptor and divalent metal transporter-1 mRNA, particularly in patients with >500 GAA1-repeats. In FA PBMCs, intracellular iron was not increased, but shifted toward mitochondria. CONCLUSIONS We provide evidence for a previously unrecognized iron starvation signature at systemic and cellular levels in FA patients, which is related to the underlying genetic severity. These findings challenge the use of systemic iron lowering therapies in FA. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Manuel Grander
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - David Haschka
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabetta Indelicato
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Amprosi
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Nachbauer
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Fischer
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Seifert
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Ibrahim A, Cesari M, Heidbreder A, Defrancesco M, Brandauer E, Seppi K, Kiechl S, Högl B, Stefani A. Sleep features and long-term incident neurodegeneration: a polysomnographic study. Sleep 2024; 47:zsad304. [PMID: 38001022 PMCID: PMC10925953 DOI: 10.1093/sleep/zsad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
STUDY OBJECTIVES Sleep is altered early in neurodegenerative diseases (NDDs) and may contribute to neurodegeneration. Long-term, large sample-size studies assessing NDDs association with objective sleep measures are scant. We aimed to investigate whether video-polysomnography (v-PSG)-based sleep features are associated with long-term NDDs incidence. METHODS Retrospective cohort study of patients referred 2004-2007 to the Sleep Disorders Unit, Neurology, Medical University Innsbruck, Austria. All patients ≥ 18 years undergoing v-PSG and without NDDs at baseline or within 5 years were included. Main outcome was NDDs diagnosis ≥5 years after v-PSG. RESULTS Of 1454 patients assessed for eligibility, 999 (68.7%) met inclusion criteria (68.3% men; median age 54.9 (IQR 33.9-62.7) years). Seventy-five patients (7.5%) developed NDDs and 924 (92.5%) remained disease-free after a median of 12.8 (IQR 9.9-14.6) years. After adjusting for demographic, sleep, and clinical covariates, a one-percentage decrease in sleep efficiency, N3-, or rapid-eye-movement (REM)-sleep was associated with 1.9%, 6.5%, or 5.2% increased risk of incident NDDs (HR 1.019, 1.065, and 1.052). One-percentage decrease in wake within sleep period time represented a 2.2% reduced risk of incident NDDs (HR 0.978). Random-forest analysis identified wake, followed by N3 and REM-sleep percentages, as the most important feature associated with NDDs diagnosis. Additionally, multiple sleep features combination improved discrimination of incident NDDs compared to individual sleep stages (concordance-index 0.72). CONCLUSIONS These findings support contribution of sleep changes to NDDs pathogenesis and provide insights into the temporal window during which these differences are detectable, pointing to sleep as early NDDs marker and potential target of neuroprotective strategies.
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Affiliation(s)
- Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michaela Defrancesco
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - 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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Stefani A, Tang Q. Recurrent Isolated Sleep Paralysis. Sleep Med Clin 2024; 19:101-109. [PMID: 38368058 DOI: 10.1016/j.jsmc.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Recurrent isolated sleep paralysis has a 7.6% lifetime prevalence of at least one episode in the general population. Episodes resolve spontaneously and are benign. Sleep paralysis represents a dissociate state, with persistence of the rapid eye movement (REM)-sleep muscle atonia in the waking state. The intrusion of alpha electroencephalogram into REM sleep is followed by an arousal response and then by persistence of REM atonia into wakefulness. Predisposing factors include irregular sleep-wake schedules, sleep deprivation, and jetlag. No drug treatment is required. Patients should be informed about sleep hygiene. Cognitive behavioral therapy may be useful in cases accompanied by anxiety and frightening hallucinations.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Qi Tang
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Šubert M, Novotný M, Tykalová T, Hlavnička J, Dušek P, Růžička E, Škrabal D, Pelletier A, Postuma RB, Montplaisir J, Gagnon JF, Galbiati A, Ferini-Strambi L, Marelli S, St Louis EK, Timm PC, Teigen LN, Janzen A, Oertel W, Heim B, Holzknecht E, Stefani A, Högl B, Dauvilliers Y, Evangelista E, Šonka K, Rusz J. Spoken Language Alterations can Predict Phenoconversion in Isolated Rapid Eye Movement Sleep Behavior Disorder: A Multicenter Study. Ann Neurol 2024; 95:530-543. [PMID: 37997483 DOI: 10.1002/ana.26835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE This study assessed the relationship between speech and language impairment and outcome in a multicenter cohort of isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). METHODS Patients with iRBD from 7 centers speaking Czech, English, German, French, and Italian languages underwent a detailed speech assessment at baseline. Story-tale narratives were transcribed and linguistically annotated using fully automated methods based on automatic speech recognition and natural language processing algorithms, leading to the 3 distinctive linguistic and 2 acoustic patterns of language deterioration and associated composite indexes of their overall severity. Patients were then prospectively followed and received assessments for parkinsonism or dementia during follow-up. The Cox proportional hazard was performed to evaluate the predictive value of language patterns for phenoconversion over a follow-up period of 5 years. RESULTS Of 180 patients free of parkinsonism or dementia, 156 provided follow-up information. After a mean follow-up of 2.7 years, 42 (26.9%) patients developed neurodegenerative disease. Patients with higher severity of linguistic abnormalities (hazard ratio [HR = 2.35]) and acoustic abnormalities (HR = 1.92) were more likely to develop a defined neurodegenerative disease, with converters having lower content richness (HR = 1.74), slower articulation rate (HR = 1.58), and prolonged pauses (HR = 1.46). Dementia-first (n = 16) and parkinsonism-first with mild cognitive impairment (n = 9) converters had higher severity of linguistic abnormalities than parkinsonism-first with normal cognition converters (n = 17). INTERPRETATION Automated language analysis might provide a predictor of phenoconversion from iRBD into synucleinopathy subtypes with cognitive impairment, and thus can be used to stratify patients for neuroprotective trials. ANN NEUROL 2024;95:530-543.
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Affiliation(s)
- Martin Šubert
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Michal Novotný
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Tereza Tykalová
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jan Hlavnička
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dominik Škrabal
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Amelie Pelletier
- Department of Neurology, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Department of Neurology, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Andrea Galbiati
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
- Department of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
- Department of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Sara Marelli
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, and Sleep Behavior and Neurophysiology Research Laboratory, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, and Sleep Behavior and Neurophysiology Research Laboratory, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
| | - Luke N Teigen
- Mayo Center for Sleep Medicine, and Sleep Behavior and Neurophysiology Research Laboratory, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
| | - Annette Janzen
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Wolfgang Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep-Wake Disorder Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM, University of Montpellier, Montpellier, France
| | - Elisa Evangelista
- National Reference Network for Narcolepsy, Sleep-Wake Disorder Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM, University of Montpellier, Montpellier, France
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Neurology & ARTORG Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ibrahim A, Stefani A, Cesari M, Roche J, Gatterer H, Holzknecht E, Turner R, Vinetti G, Furian M, Heidbreder A, Högl B, Siebenmann C. Effects of periodic breathing on sleep at high altitude: a randomized, placebo-controlled, crossover study using inspiratory CO 2. J Physiol 2024. [PMID: 38408065 DOI: 10.1113/jp285397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/17/2024] [Indexed: 02/28/2024] Open
Abstract
Hypoxia at high altitude facilitates changes in ventilatory control that can lead to nocturnal periodic breathing (nPB). Here, we introduce a placebo-controlled approach to prevent nPB by increasing inspiratory CO2 and used it to assess whether nPB contributes to the adverse effects of hypoxia on sleep architecture. In a randomized, single-blinded, crossover design, 12 men underwent two sojourns (three days/nights each, separated by 4 weeks) in hypobaric hypoxia corresponding to 4000 m altitude, with polysomnography during the first and third night of each sojourn. During all nights, subjects' heads were encompassed by a canopy retaining exhaled CO2 , and CO2 concentration in the canopy (i.e. inspiratory CO2 concentration) was controlled by adjustment of fresh air inflow. Throughout the placebo sojourn inspiratory CO2 was ≤0.2%, whereas throughout the other sojourn it was increased to 1.76% (IQR, 1.07%-2.44%). During the placebo sojourn, total sleep time (TST) with nPB was 54.3% (37.4%-80.8%) and 45.0% (24.5%-56.5%) during the first and the third night, respectively (P = 0.042). Increased inspiratory CO2 reduced TST with nPB by an absolute 38.1% (28.1%-48.1%), the apnoea-hypopnoea index by 58.1/h (40.1-76.1/h), and oxygen desaturation index ≥3% by 56.0/h (38.9.1-73.2/h) (all P < 0.001), whereas it increased the mean arterial oxygen saturation in TST by 2.0% (0.4%-3.5%, P = 0.035). Increased inspiratory CO2 slightly increased the percentage of N3 sleep during the third night (P = 0.045), without other effects on sleep architecture. Increasing inspiratory CO2 effectively prevented hypoxia-induced nPB without affecting sleep macro-architecture, indicating that nPB does not explain the sleep deterioration commonly observed at high altitudes. KEY POINTS: Periodic breathing is common during sleep at high altitude, and it is unclear how this affects sleep architecture. We developed a placebo-controlled approach to prevent nocturnal periodic breathing (nPB) with inspiratory CO2 administration and used it to assess the effects of nPB on sleep in hypobaric hypoxia. Nocturnal periodic breathing was effectively mitigated by an increased inspiratory CO2 fraction in a blinded manner. Prevention of nPB did not lead to relevant changes in sleep architecture in hypobaric hypoxia. We conclude that nPB does not explain the deterioration in sleep architecture commonly observed at high altitude.
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Affiliation(s)
- Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johanna Roche
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rachel Turner
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Giovanni Vinetti
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2023:17474930231212349. [PMID: 37885093 DOI: 10.1177/17474930231212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage-Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage-Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Bergmann M, Högl B, Ibrahim A, Brandauer E, Heidbreder A, Stefani A, Cesari M. A reliable automatic algorithm to score fragmentary myoclonus. J Sleep Res 2023; 32:e13921. [PMID: 37132127 DOI: 10.1111/jsr.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
Excessive fragmentary myoclonus (EFM) is an incidental polysomnographic finding requiring documentation of ≥20 minutes of NREM sleep with ≥5 fragmentary myoclonus (FM) potentials per minute. Manual FM scoring is time-consuming and prone to inter-rater variability. This work aimed to validate an automatic algorithm to score FM in whole-night recordings. One expert scorer manually scored FM in the anterior tibialis muscles in 10 polysomnographies of as many subjects. The algorithm consisted of two steps. First, parameters of the automatic leg movement identification algorithm of the BrainRT software (OSG, Belgium) were modified to identify FM-like activity. Second, a post-processing algorithm was implemented to remove FM activity not meeting sufficient amplitude criteria. The parameter choice and the post-processing were optimised with leave-one-out cross-validation. Agreement with the human scorer was measured with Cohen's kappa (k) and correlation between manual and automatic FM indices in different sleep stages was evaluated. Agreement in identifying patients with EFM was computed. The algorithm showed substantial agreement (average k > 0.62) for all sleep stages, except for W, where a moderate agreement was observed (average k = 0.58). Nonetheless, the agreement between human scorer and the algorithm was similar to previously reported values of inter-rater variability for FM scoring. Correlation coefficients were over 0.96 for all sleep stages. Furthermore, the presence/absence of EFM was correctly identified in 80% of the subjects. In conclusion, this work presents a reliable algorithm for automatic scoring of FM and EFM. Future studies will apply it to objectively and consistently evaluate FM indices and the presence of EFM in large populations.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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10
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Joza S, Iranzo A, Stefani A, Pelletier A, Serradell M, Muñoz‐Lopetegi A, Ibrahim A, Holzknecht E, Montplaisir JY, Mayà G, Santamaria J, Gaig C, Bergmann M, Brandauer E, Högl B, Gagnon J, Postuma RB. Is REM Sleep Behavior Disorder Changing? Secular Changes Versus Referral Patterns. Mov Disord Clin Pract 2023; 10:1519-1524. [PMID: 37868932 PMCID: PMC10585963 DOI: 10.1002/mdc3.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 10/24/2023] Open
Abstract
Background Since 2014, there has been increasing public outreach effort regarding isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) in Montreal. Objective To assess if, over time, milder iRBD cases are presenting earlier. Methods Disease-free survival was compared in two iRBD recruitment epochs: 2004 to 2013 ("earlier") versus 2014to 2022 ("later") and by referral type ("self-referral" vs. "conventional-referral") in three large centers. Results In Montreal, among 209 subjects followed prospectively, shorter time to phenoconversion was observed in the earlier epoch (5-year phenoconversion = 42% earlier vs. 23% later); diagnosis before 2014 had a 1.8-fold phenoconversion hazard. However, no difference was observed in 248 subjects from Barcelona and 166 from Innsbruck. Analysis of Montreal data found that increased survival in the later epoch was driven by an increasing number of self-referrals, who phenoconverted at 1/3 the rate of physician-referred subjects. Conclusions Increased patient awareness of iRBD results in earlier presentation to clinical attention, with a longer time to phenoconversion.
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Affiliation(s)
- Stephen Joza
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
| | - Alex Iranzo
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Ambra Stefani
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Amelie Pelletier
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
| | - Monica Serradell
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Amaia Muñoz‐Lopetegi
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Abubaker Ibrahim
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Evi Holzknecht
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Jacques Y. Montplaisir
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Gerard Mayà
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Joan Santamaria
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Carles Gaig
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Melanie Bergmann
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | | | - Birgit Högl
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Jean‐François Gagnon
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Ronald B. Postuma
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
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11
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Yu E, Krohn L, Ruskey JA, Asayesh F, Spiegelman D, Shah Z, Chia R, Arnulf I, Hu MTM, Montplaisir JY, Gagnon J, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Högl B, Stefani A, Ibrahim A, Heidbreder A, Sonka K, Dusek P, Kemlink D, Oertel W, Janzen A, Plazzi G, Antelmi E, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel‐Döring F, Cochen De Cock V, Ferini‐Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Rouleau GA, Postuma RB, Scholz SW, Gan‐Or Z. HLA in isolated REM sleep behavior disorder and Lewy body dementia. Ann Clin Transl Neurol 2023; 10:1682-1687. [PMID: 37401389 PMCID: PMC10502660 DOI: 10.1002/acn3.51841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
Synucleinopathies-related disorders such as Lewy body dementia (LBD) and isolated/idiopathic REM sleep behavior disorder (iRBD) have been associated with neuroinflammation. In this study, we examined whether the human leukocyte antigen (HLA) locus plays a role in iRBD and LBD. In iRBD, HLA-DRB1*11:01 was the only allele passing FDR correction (OR = 1.57, 95% CI = 1.27-1.93, p = 2.70e-05). We also discovered associations between iRBD and HLA-DRB1 70D (OR = 1.26, 95%CI = 1.12-1.41, p = 8.76e-05), 70Q (OR = 0.81, 95%CI = 0.72-0.91, p = 3.65e-04) and 71R (OR = 1.21, 95%CI = 1.08-1.35, p = 1.35e-03). Position 71 (pomnibus = 0.00102) and 70 (pomnibus = 0.00125) were associated with iRBD. Our results suggest that the HLA locus may have different roles across synucleinopathies.
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Affiliation(s)
- Eric Yu
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
| | - Lynne Krohn
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
| | - Jennifer A. Ruskey
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Farnaz Asayesh
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Dan Spiegelman
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Zalak Shah
- Neurodegenerative Diseases Research UnitNational Institute of Neurological Disorders and StrokeBethesdaMarylandUSA
| | - Ruth Chia
- Neuromuscular Diseases Research SectionNational Institute on AgingBethesdaMarylandUSA
| | - Isabelle Arnulf
- Sleep Disorders Unit, Pitié Salpêtrière HospitalParis Brain Institute and Sorbonne UniversityParisFrance
| | - Michele T. M. Hu
- Oxford Parkinson's Disease Centre (OPDC)University of OxfordOxfordUK
- Division of Neurology, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Jacques Y. Montplaisir
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
- Department of PsychiatryUniversité de MontréalMontréalQuébecCanada
| | - Jean‐François Gagnon
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
- Department of PsychologyUniversité du Québec à MontréalMontréalQuébecCanada
| | - Alex Desautels
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
- Department of NeurosciencesUniversité de MontréalMontréalQuébecCanada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui‐de‐Chauliac Hospital, CHU MontpellierUniversity of Montpellier, Inserm U1061MontpellierFrance
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
- Department of Medicine (DAME)University of UdineUdineItaly
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
- Department of Medicine (DAME)University of UdineUdineItaly
| | - Francesco Janes
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
| | - Andrea Bernardini
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
| | - Birgit Högl
- Sleep Disorders Clinic, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Heidbreder
- Department for Sleep Medicine and Neuromuscular diseaseUniversity Hospital MuensterMuensterGermany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, First Faculty of Medicine and General University HospitalPragueCzech Republic
| | - Petr Dusek
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, First Faculty of Medicine and General University HospitalPragueCzech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, First Faculty of Medicine and General University HospitalPragueCzech Republic
| | | | - Annette Janzen
- Department of NeurologyPhilipps UniversityMarburgGermany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio‐EmiliaModenaItaly
- IRCCS, Institute of Neurological Sciences of BolognaBolognaItaly
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research CenterUniversity of CagliariCagliariItaly
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research CenterUniversity of CagliariCagliariItaly
| | - Brit Mollenhauer
- Paracelsus‐Elena‐KlinikKasselGermany
- Department of NeurosurgeryUniversity Medical Centre GöttingenGöttingenGermany
| | - Claudia Trenkwalder
- Paracelsus‐Elena‐KlinikKasselGermany
- Department of NeurosurgeryUniversity Medical Centre GöttingenGöttingenGermany
| | - Friederike Sixel‐Döring
- Department of NeurologyPhilipps UniversityMarburgGermany
- Paracelsus‐Elena‐KlinikKasselGermany
| | - Valérie Cochen De Cock
- Sleep and Neurology UnitBeau Soleil ClinicMontpellierFrance
- EuroMov Digital Health in MotionUniversity of Montpellier IMT Mines AlesMontpellierFrance
| | - Luigi Ferini‐Strambi
- Department of Neurological SciencesUniversità Vita‐Salute San RaffaeleMilanItaly
| | - Femke Dijkstra
- Laboratory for Sleep DisordersSt. Dimpna Regional HospitalGeelBelgium
- Department of NeurologySt. Dimpna Regional HospitalGeelBelgium
- Department of NeurologyUniversity Hospital AntwerpEdegemAntwerpBelgium
| | - Mineke Viaene
- Laboratory for Sleep DisordersSt. Dimpna Regional HospitalGeelBelgium
- Department of NeurologySt. Dimpna Regional HospitalGeelBelgium
| | - Beatriz Abril
- Sleep disorder UnitCarémeau Hospital, University Hospital of NîmesNîmesFrance
| | | | - Guy A. Rouleau
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Ronald B. Postuma
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
| | | | - Sonja W. Scholz
- Neurodegenerative Diseases Research UnitNational Institute of Neurological Disorders and StrokeBethesdaMarylandUSA
- Department of NeurologyJohns Hopkins University Medical CenterBaltimoreMarylandUSA
| | - Ziv Gan‐Or
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
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12
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Ibrahim A, Ferri R, Cesari M, Frauscher B, Heidbreder A, Bergmann M, Högl B, Stefani A. Large muscle group movements during sleep in healthy people: normative values and correlation to sleep features. Sleep 2023; 46:zsad129. [PMID: 37129552 PMCID: PMC10424171 DOI: 10.1093/sleep/zsad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
STUDY OBJECTIVES To investigate the frequency and characteristics of large muscle group movements (LMMs) during sleep in healthy adults. METHODS LMMs were scored following the International Restless Legs Syndrome Study Group criteria in 100 healthy participants aged 19-77 years. A LMM was defined as a temporally overlapping increase in EMG activity and/or the occurrence of movement artifacts in at least two channels. LMM indices and durations in total sleep time (TST), NREM and REM sleep, and association with arousals, awakenings, and/or respiratory events were calculated. Correlations of LMMs indices and durations with sleep architecture, respiratory and motor events, and subjective sleep quality were investigated. RESULTS Median LMMs index in TST was 6.8/h (interquartile range (IQR), 4.5-10.8/h), median mean duration 12.4 s (IQR 10.7-14.4 s). Mean LMMs duration was longer in NREM (median 12.7 s, IQR 11.1-15.2 s) versus REM sleep (median 10.3 s, IQR 8.0-13.5s), p < 0.001. LMMs associated with awakening increased with age (p = 0.029). LMMs indices in TST were higher in men than women (p = 0.018). LMMs indices correlated positively with N1 sleep percentage (ρ = 0.49, p < 0.001), arousal index (ρ = 0.40, p = 0.002), sleep stages shift index (ρ = 0.43, p < 0.001, apnea index (ρ = 0.36, p = 0.017), and video-visible movements indices (ρ = 0.45, p < 0.001), and negatively with N3 sleep (ρ = -0.38, p= 0.004) percentage. CONCLUSIONS This is the first study providing normative data on LMMs frequency in healthy adults. LMMs are a ubiquitous phenomenon often associated with other events. Correlation with arousals and respiratory events suggests a potential clinical significance of LMMs in adults that awaits further investigation.
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Affiliation(s)
- Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - 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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13
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Stefani A, Högl B, Videnovic A. Sodium oxybate-a new horizon for symptomatic treatment of RBD? Sleep 2023; 46:zsad150. [PMID: 37232455 PMCID: PMC10424167 DOI: 10.1093/sleep/zsad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Ambra Stefani
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, USA
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Aleksandar Videnovic
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, USA
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14
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Harrer P, Mirza-Schreiber N, Mandel V, Roeber S, Stefani A, Naher S, Wagner M, Gieger C, Waldenberger M, Peters A, Högl B, Herms J, Schormair B, Zhao C, Winkelmann J, Oexle K. Epigenetic Association Analyses and Risk Prediction of RLS. Mov Disord 2023; 38:1410-1418. [PMID: 37212434 DOI: 10.1002/mds.29440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND As opposed to other neurobehavioral disorders, epigenetic analyses and biomarkers are largely missing in the case of idiopathic restless legs syndrome (RLS). OBJECTIVES Our aims were to develop a biomarker for RLS based on DNA methylation in blood and to examine DNA methylation in brain tissues for dissecting RLS pathophysiology. METHODS Methylation of blood DNA from three independent cohorts (n = 2283) and post-mortem brain DNA from two cohorts (n = 61) was assessed by Infinium EPIC 850 K BeadChip. Epigenome-wide association study (EWAS) results of individual cohorts were combined by random-effect meta-analysis. A three-stage selection procedure (discovery, n = 884; testing, n = 520; validation, n = 879) established an epigenetic risk score including 30 CpG sites. Epigenetic age was assessed by Horvath's multi-tissue clock and Shireby's cortical clock. RESULTS EWAS meta-analysis revealed 149 CpG sites linked to 136 genes (P < 0.05 after Bonferroni correction) in blood and 23 CpG linked to 18 genes in brain (false discovery rate [FDR] < 5%). Gene-set analyses of blood EWAS results suggested enrichments in brain tissue types and in subunits of the kainate-selective glutamate receptor complex. Individual candidate genes of the brain EWAS could be assigned to neurodevelopmental or metabolic traits. The blood epigenetic risk score achieved an area under the curve (AUC) of 0.70 (0.67-0.73) in the validation set, comparable to analogous scores in other neurobehavioral disorders. A significant difference in biological age in blood or brain of RLS patients was not detectable. CONCLUSIONS DNA methylation supports the notion of altered neurodevelopment in RLS. Epigenetic risk scores are reliably associated with RLS but require even higher accuracy to be useful as biomarkers. © 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)
- Philip Harrer
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nazanin Mirza-Schreiber
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Neurogenetic Systems Analysis Group, Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Vanessa Mandel
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
- Neurogenetic Systems Analysis Group, Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Shamsun Naher
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Neurogenetic Systems Analysis Group, Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Matias Wagner
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Barbara Schormair
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Chen Zhao
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Neurogenetic Systems Analysis Group, Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Chair of Neurogenetics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Konrad Oexle
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
- Neurogenetic Systems Analysis Group, Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
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15
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Cesari M, Ruzicka L, Högl B, Ibrahim A, Holzknecht E, Heidbreder A, Bergmann M, Brandauer E, Garn H, Kohn B, Stefani A. Improved automatic identification of isolated rapid eye movement sleep behavior disorder with a 3D time-of-flight camera. Eur J Neurol 2023; 30:2206-2214. [PMID: 37151137 PMCID: PMC10947372 DOI: 10.1111/ene.15822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Automatic 3D video analysis of the lower body during rapid eye movement (REM) sleep has been recently proposed as a novel tool for identifying people with isolated REM sleep behavior disorder (iRBD), but, so far, it has not been validated on unseen subjects. This study aims at validating this technology in a large cohort and at improving its performances by also including an analysis of movements in the head, hands and upper body. METHODS Fifty-three people with iRBD and 128 people without RBD (of whom 89 had sleep disorders considered RBD differential diagnoses) were included in the study. An automatic algorithm identified movements from 3D videos during REM sleep in four regions of interest (ROIs): head, hands, upper body and lower body. The movements were divided into categories according to duration: short (0.1-2 s), medium (2-15 s) and long (15-300 s). For each ROI and duration range, features were obtained from the identified movements. Logistic regression models using as predictors the features from one single ROI or a combination of ROIs were trained and tested in a 10-runs 10-fold cross-validation scheme on the task of differentiating people with iRBD from people without RBD. RESULTS The best differentiation was achieved using short movements in all four ROIs (test accuracy 0.866 ± 0.007, test F1 score = 0.783 ± 0.010). Single group analyses showed that people with iRBD were distinguished successfully from subjects with RBD differential diagnoses. CONCLUSIONS Automatic 3D video analysis might be implemented in clinical routine as a supportive screening tool for identifying people with RBD.
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Affiliation(s)
- Matteo Cesari
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Laurenz Ruzicka
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Birgit Högl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Abubaker Ibrahim
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Evi Holzknecht
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Heidbreder
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Melanie Bergmann
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Heinrich Garn
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Bernhard Kohn
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Ambra Stefani
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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Stefani A, Serradell M, Holzknecht E, Gaig C, Ibrahim A, Marrero P, Cesari M, Pérez-Carbonell L, Brandauer E, Fernández-Arcos A, Bergmann M, Matos N, Santamaria J, Högl B, Iranzo A. Low Specificity of Rapid Eye Movement Sleep Behavior Disorder Questionnaires: Need for Better Screening Methods. Mov Disord 2023; 38:1000-1007. [PMID: 37147274 DOI: 10.1002/mds.29407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is critical due to its link to α-synucleinopathies and risk of injuries and requires video-polysomnography (V-PSG). Usefulness of screening questionnaires outside the context of validation studies is limited. OBJECTIVE The aim was to assess the performance of three validated RBD screening questionnaires compared with gold-standard V-PSG. METHODS In this bicentric prospective study, 400 consecutive subjects referred to a sleep center for the first time filled three RBD questionnaires (RBD Screening Questionnaire, RBD Single Question, and Innsbruck RBD Inventory) in random order before sleep experts' interview. Subjects positive for at least one questionnaire were invited to undergo V-PSG. Data from patients negative for all questionnaires undergoing V-PSG for other reasons were also evaluated. Questionnaire performances were compared to gold-standard V-PSG RBD diagnosis. RESULTS Three hundred ninety-nine patients (median age: 51 [interquartile range: 37-64] years, 54.9% men) participated. Two hundred thirty-eight (59.6%) were positive for at least one questionnaire, and RBD was diagnosed using V-PSG in 30 patients (7.5%). Questionnaire specificity was 48.1% to 67.4%, sensitivity 80% to 92%, accuracy 51% to 68.3%, negative predictive value 94.2% to 98%, and positive predictive value 14.1% to 20.7%, with no relevant differences in performances among the evaluated questionnaires. CONCLUSIONS RBD questionnaires have low specificity and low positive predictive value and should not be used as a standalone tool for the diagnosis of RBD. Further development of RBD screening methods is needed, particularly for upcoming neuroprotective trials. © 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)
- Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Monica Serradell
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Evi Holzknecht
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paula Marrero
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Matteo Cesari
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Pérez-Carbonell
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Elisabeth Brandauer
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ana Fernández-Arcos
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Melanie Bergmann
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuria Matos
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
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17
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Ollila HM, Sharon E, Lin L, Sinnott-Armstrong N, Ambati A, Yogeshwar SM, Hillary RP, Jolanki O, Faraco J, Einen M, Luo G, Zhang J, Han F, Yan H, Dong XS, Li J, Zhang J, Hong SC, Kim TW, Dauvilliers Y, Barateau L, Lammers GJ, Fronczek R, Mayer G, Santamaria J, Arnulf I, Knudsen-Heier S, Bredahl MKL, Thorsby PM, Plazzi G, Pizza F, Moresco M, Crowe C, Van den Eeden SK, Lecendreux M, Bourgin P, Kanbayashi T, Martínez-Orozco FJ, Peraita-Adrados R, Benetó A, Montplaisir J, Desautels A, Huang YS, Jennum P, Nevsimalova S, Kemlink D, Iranzo A, Overeem S, Wierzbicka A, Geisler P, Sonka K, Honda M, Högl B, Stefani A, Coelho FM, Mantovani V, Feketeova E, Wadelius M, Eriksson N, Smedje H, Hallberg P, Hesla PE, Rye D, Pelin Z, Ferini-Strambi L, Bassetti CL, Mathis J, Khatami R, Aran A, Nampoothiri S, Olsson T, Kockum I, Partinen M, Perola M, Kornum BR, Rueger S, Winkelmann J, Miyagawa T, Toyoda H, Khor SS, Shimada M, Tokunaga K, Rivas M, Pritchard JK, Risch N, Kutalik Z, O'Hara R, Hallmayer J, Ye CJ, Mignot EJ. Narcolepsy risk loci outline role of T cell autoimmunity and infectious triggers in narcolepsy. Nat Commun 2023; 14:2709. [PMID: 37188663 DOI: 10.1038/s41467-023-36120-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2023] [Indexed: 05/17/2023] Open
Abstract
Narcolepsy type 1 (NT1) is caused by a loss of hypocretin/orexin transmission. Risk factors include pandemic 2009 H1N1 influenza A infection and immunization with Pandemrix®. Here, we dissect disease mechanisms and interactions with environmental triggers in a multi-ethnic sample of 6,073 cases and 84,856 controls. We fine-mapped GWAS signals within HLA (DQ0602, DQB1*03:01 and DPB1*04:02) and discovered seven novel associations (CD207, NAB1, IKZF4-ERBB3, CTSC, DENND1B, SIRPG, PRF1). Significant signals at TRA and DQB1*06:02 loci were found in 245 vaccination-related cases, who also shared polygenic risk. T cell receptor associations in NT1 modulated TRAJ*24, TRAJ*28 and TRBV*4-2 chain-usage. Partitioned heritability and immune cell enrichment analyses found genetic signals to be driven by dendritic and helper T cells. Lastly comorbidity analysis using data from FinnGen, suggests shared effects between NT1 and other autoimmune diseases. NT1 genetic variants shape autoimmunity and response to environmental triggers, including influenza A infection and immunization with Pandemrix®.
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Affiliation(s)
- Hanna M Ollila
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Eilon Sharon
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Ling Lin
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Nasa Sinnott-Armstrong
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Aditya Ambati
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Selina M Yogeshwar
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Department of Neurology, Charité-Universitätsmedizin, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, 10117, Berlin, Germany
| | - Ryan P Hillary
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Otto Jolanki
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Juliette Faraco
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Mali Einen
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Guo Luo
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Jing Zhang
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Fang Han
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Han Yan
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Xiao Song Dong
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jing Li
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurology, The Peking University People's Hospital, Beijing, China
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Tae Won Kim
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Geert Mayer
- Hephata Klinik, Schimmelpfengstr. 6, 34613, Schwalmstadt, Germany
- Philipps Universität Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Joan Santamaria
- Neurology Service, Institut de Neurociències Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, 75013, Paris, France
| | - Stine Knudsen-Heier
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - May Kristin Lyamouri Bredahl
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Monica Moresco
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | | | - Michel Lecendreux
- Pediatric Sleep Center and National Reference Center for Narcolepsy and Idiopathic Hypersomnia Hospital Robert Debre, Paris, France
| | - Patrice Bourgin
- Department of Sleep Medicine, Strasbourg University Hospital, Strasbourg University, Strasbourg, France
| | - Takashi Kanbayashi
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Francisco J Martínez-Orozco
- Sleep Unit. Clinical Neurophysiology Service. San Carlos University Hospital. University Complutense of Madrid, Madrid, Spain
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit, Clinical Neurophysiology Service, Gregorio Marañón University General Hospital and Research Institute, University Complutense of Madrid (UCM), Madrid, Spain
| | | | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
| | - Sona Nevsimalova
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Alex Iranzo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Neurology, Barcelona, Spain
- Multidisciplinary Sleep Disorders Unit, Barcelona, Spain
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, P.O. Box 61, 5590 AB, Heeze, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Makoto Honda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Seiwa Hospital, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | | | - Vilma Mantovani
- Center for Applied Biomedical Research (CRBA), St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Mia Wadelius
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Niclas Eriksson
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - Hans Smedje
- Division of Child and Adolescent Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Pär Hallberg
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - David Rye
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zerrin Pelin
- Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Claudio L Bassetti
- Neurology Department, EOC, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Adi Aran
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Centre, Kerala, India
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Markus Perola
- University of Helsinki, Institute for Molecular Medicine, Finland (FIMM) and Diabetes and Obesity Research Program. University of Tartu, Estonian Genome Center, Tartu, Estonia
| | - Birgitte R Kornum
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Sina Rueger
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Taku Miyagawa
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Toyoda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Seik-Soon Khor
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mihoko Shimada
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manuel Rivas
- Department of Biomedical Data Science-Administration, Stanford University, Palo Alto, CA, USA
| | | | - Neil Risch
- Dept. Epidemiology and Biostatistics, UCSF, 513 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Zoltan Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland, Lausanne, 1010, Switzerland
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Chun Jimmie Ye
- Department of Epidemiology & Biostatistics, Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Emmanuel J Mignot
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA.
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Stefani A, Cesari M. Digital health technologies and digital biomarkers in RBD: Need for order out of chaos. Sleep 2023:7111698. [PMID: 37036128 DOI: 10.1093/sleep/zsad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Ambra Stefani
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston, USA
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Bergmann M, Wanschitz J, Stefani A, Heidbreder A, Brandauer E, Cesari M, Löscher WN, Högl B. A prospective case-control study of excessive fragmentary myoclonus in the upper and lower extremities: Clinical characteristics and electrophysiological correlates. Sleep Med 2023; 106:84-89. [PMID: 37075530 DOI: 10.1016/j.sleep.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Excessive fragmentary myoclonus (EFM) is an incidental finding in video-polysomnography (VPSG) and listed among "Sleep Related Movement Disorders - Isolated symptoms and normal variants" in the ICSD-3. We aimed to prospectively evaluate EFM in the upper and lower extremities in a large sleep laboratory cohort and to investigate clinical characteristics and peripheral nerve pathology in patients with and without EFM. METHODS Two-hundred consecutive sleep laboratory patients with EFM according to ICSD-3 criteria were included and matched to 100 patients without EFM for age, sex and presence or absence of sleep-related breathing disorder. Patients additionally underwent peripheral neurophysiological work-up. RESULTS In 31/200 (15.5%) patients EFM was present not only in the lower extremities, but also in the upper extremities. Patients with EFM had less REM sleep (%/SPT; median (IQR); 13.8 (9.1-18.2) vs. 17.1 (10.1-20.5); p = 0.008) and the PLMS-Index was higher in patients with EFM than in those without (16.2 vs. 8.8/h; p = 0.009). Polyneuropathy (PNP) and nerve root lesions L5 and S1 were more frequent in patients with than in those without EFM (31.5% vs. 21% and 5% vs. 0%; p = 0.003). CONCLUSIONS In this large cohort we systematically investigated upper and lower extremities with surface electromyography during sleep and show that EFM is much more frequent in the lower extremities than in the upper extremities and corroborate the association of EFM with peripheral nerve pathology and PLMS.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Austria.
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Austria
| | | | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Austria
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Yu E, Krohn L, Ruskey JA, Asayesh F, Spiegelman D, Shah Z, Chia R, Arnulf I, Hu MT, Montplaisir JY, Gagnon JF, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Högl B, Stefani A, Ibrahim A, Heidbreder A, Sonka K, Dusek P, Kemlink D, Oertel W, Janzen A, Plazzi G, Antelmi E, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel-Döring F, De Cock VC, Ferini-Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Rouleau GA, Postuma RB, Scholz SW, Gan-Or Z. HLA in isolated REM sleep behavior disorder and Lewy body dementia. medRxiv 2023:2023.01.31.23284682. [PMID: 36778313 PMCID: PMC9915822 DOI: 10.1101/2023.01.31.23284682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and Objectives Isolated/idiopathic REM sleep behavior disorder (iRBD) and Lewy body dementia (LBD) are synucleinopathies that have partial genetic overlap with Parkinson's disease (PD). Previous studies have shown that neuroinflammation plays a substantial role in these disorders. In PD, specific residues of the human leukocyte antigen ( HLA ) were suggested to be associated with a protective effect. This study examined whether the HLA locus plays a similar role in iRBD, LBD and PD. Methods We performed HLA imputation on iRBD genotyping data (1,072 patients and 9,505 controls) and LBD whole-genome sequencing (2,604 patients and 4,032 controls) using the multi-ethnic HLA reference panel v2 from the Michigan Imputation Server. Using logistic regression, we tested the association of HLA alleles, amino acids and haplotypes with disease susceptibility. We included age, sex and the top 10 principal components as covariates. We also performed an omnibus test to examine which HLA residue positions explain the most variance. Results In iRBD, HLA-DRB1 *11:01 was the only allele passing FDR correction (OR=1.57, 95% CI=1.27-1.93, p =2.70e-05). We also discovered associations between iRBD and HLA-DRB1 70D (OR=1.26, 95%CI=1.12-1.41, p =8.76e-05), 70Q (OR=0.81, 95% CI=0.72-0.91, p =3.65e-04) and 71R (OR=1.21, 95% CI=1.08-1.35, p =1.35e-03). In HLA-DRB1 , position 71 ( p omnibus =0.00102) and 70 ( p omnibus =0.00125) were associated with iRBD. We found no association in LBD. Discussion This study identified an association between HLA-DRB1 11:01 and iRBD, distinct from the previously reported association in PD. Therefore, the HLA locus may play different roles across synucleinopathies. Additional studies are required better to understand HLA's role in iRBD and LBD.
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Affiliation(s)
- Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Jennifer A. Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Dan Spiegelman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Zalak Shah
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Ruth Chia
- Neuromuscular Diseases Research Section, National Institute on Aging, Bethesda, MD, USA
| | - Isabelle Arnulf
- Sleep Disorders Unit, Pitié Salpêtrière Hospital, Paris Brain Institute and Sorbonne University, Paris, France
| | - Michele T.M. Hu
- Oxford Parkinson’s Disease Centre (OPDC), University of Oxford, Oxford, United Kingdom
- Division of Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jacques Y. Montplaisir
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montreal, Montréal, QC, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Universite de Montréal, Montréal, QC, Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Inserm U1061, Montpellier, France
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department for Sleep Medicine and Neuromuscular disease, University Hospital Muenster, Muenster, Germany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
| | - Annette Janzen
- Department of Neurology, Philipps University, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Centre Gættingen, Gottingen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Centre Gættingen, Gottingen, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps University, Marburg, Germany
- Paracelsus-Elena-Klinik, Kassel, Germany
| | - Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France
- EuroMov Digital Health in Motion, University of Montpellier IMT Mines Ales, Montpellier, France
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Femke Dijkstra
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, University Hospital Antwerp, Edegem, Antwerp, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
| | - Beatriz Abril
- Sleep disorder Unit, Carémeau Hospital, University Hospital of Nîmes, France
| | | | - Guy A. Rouleau
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Ronald B. Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Sonja W. Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | | | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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21
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Belluomini L, Ferrara M, Sposito M, Vitale A, Insolda J, Vita E, Giannarelli D, Stefani A, Milella M, Bria E, Pilotto S. 23P Impact of PDL1 expression on outcomes of patients with EGFR mutant NSCLC treated with EGFR TKIs: First results of the POET study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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22
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Stefani A, Trenkwalder C, Arnulf I, Bliwise DL, Boeve BF, Inoue Y, Iranzo A, Lewis SJ, Provini F, Schenck C, Wenning GK, Wing YK, Hogl B, Videnovic A. Isolated rapid eye movement sleep behaviour disorder: clinical and research implications. J Neurol Neurosurg Psychiatry 2023:jnnp-2022-330913. [PMID: 36977554 DOI: 10.1136/jnnp-2022-330913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia Trenkwalder
- Paracelsus Elena Klinik, Kassel, Germany
- Neurologische Klinik, Georg August Universität, Göttingen, Germany
| | - 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 Univ Paris 06, Paris, France
| | - Donald L Bliwise
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Simon Jg Lewis
- Healthy Brain Ageing Clinic, University of Sydney, Sydney, New South Wales, Australia
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences and IRCCS Institute of Neurosciences, Bologna, University of Bologna, Bologna, Italy
| | - Carlos Schenck
- Dept. of Psychiatry and Sleep Disorders Center, Minnesota Regional Sleep Disorders Center and University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Yun Kwok Wing
- Psychiatry, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Birgit Hogl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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23
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Cesari M, Heidbreder A, Gaig C, Bergmann M, Brandauer E, Iranzo A, Holzknecht E, Santamaria J, Högl B, Stefani A. Automatic analysis of muscular activity in the flexor digitorum superficialis muscles: a fast screening method for rapid eye movement sleep without atonia. Sleep 2023; 46:zsab299. [PMID: 34984464 PMCID: PMC9995778 DOI: 10.1093/sleep/zsab299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To identify a fast and reliable method for rapid eye movement (REM) sleep without atonia (RWA) quantification. METHODS We analyzed 36 video-polysomnographies (v-PSGs) of isolated REM sleep behavior disorder (iRBD) patients and 35 controls' v-PSGs. Patients diagnosed with RBD had: i) RWA, quantified with a reference method, i.e. automatic and artifact-corrected 3-s Sleep Innsbruck Barcelona (SINBAR) index in REM sleep periods (RSPs, i.e. manually selected portions of REM sleep); and ii) v-PSG-documented RBD behaviors. We quantified RWA with other (semi)-automated methods requiring less human intervention than the reference one: the indices proposed by the SINBAR group (the 3-s and 30-s phasic flexor digitorum superficialis (FDS), phasic/"any"/tonic mentalis), and the REM atonia, short and long muscle activity indices (in mentalis/submentalis/FDS muscles). They were calculated in whole REM sleep (i.e. REM sleep scored following international guidelines), in RSPs, with and without manual artifact correction. Area under curves (AUC) discriminating iRBD from controls were computed. Using published cut-offs, the indices' sensitivity and specificity for iRBD identification were calculated. Apnea-hypopnea index in REM sleep (AHIREM) was considered in the analyses. RESULTS RWA indices from FDS muscles alone had the highest AUCs and all of them had 100% sensitivity. Without manual RSP selection and artifact correction, the "30-s phasic FDS" and the "FDS long muscle activity" had the highest specificity (85%) with AHIREM < 15/h. RWA indices were less reliable when AHIREM≥15/h. CONCLUSIONS If AHIREM<15/h, FDS muscular activity in whole REM sleep and without artifact correction is fast and reliable to rule out RWA.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Iranzo
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - 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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24
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Joza S, Hu MT, Jung KY, Kunz D, Stefani A, Dušek P, Terzaghi M, Arnaldi D, Videnovic A, Schiess MC, Hermann W, Lee JY, Ferini-Strambi L, Lewis SJG, Leclair-Visonneau L, Oertel WH, Antelmi E, Sixel-Döring F, Cochen De Cock V, Liguori C, Liu J, Provini F, Puligheddu M, Nicoletti A, Bassetti CLA, Bušková J, Dauvilliers Y, Ferri R, Montplaisir JY, Lawton M, Kim HJ, Bes F, Högl B, Šonka K, Fiamingo G, Pietro M, Lavadia ML, Suescun J, Woo KA, Marelli S, Ehgoetz Martens K, Janzen A, Plazzi G, Mollenhauer B, Fernandes M, Li Y, Cortelli P, Figorilli M, Cicero CE, Schaefer C, Guiraud L, Lanza G, Gagnon JF, Sunwoo JS, Ibrahim A, Girtler N, Trenkwalder C, Baldelli L, Pelletier A, Postuma RB. Progression of clinical markers in prodromal Parkinson's disease and dementia with Lewy bodies: a multicentre study. Brain 2023:7071614. [PMID: 36881989 DOI: 10.1093/brain/awad072] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 03/09/2023] Open
Abstract
The neurodegenerative synucleinopathies, including Parkinson's disease and dementia with Lewy bodies, are characterized by a typically lengthy prodromal period of progressive subclinical motor and non-motor manifestations. Among these, idiopathic REM sleep behavior disorder (iRBD) is a powerful early predictor of eventual phenoconversion, and therefore represents a critical opportunity to intervene with neuroprotective therapy. To inform the design of randomized trials, it is essential to study the natural progression of clinical markers during the prodromal stages of disease in order to establish optimal clinical endpoints. In this study, we combined prospective follow-up data from 28 centers of the International REM Sleep Behavior Disorder Study Group representing 12 countries. Polysomnogram-confirmed REM sleep behavior disorder subjects were assessed for prodromal Parkinson's disease using the Movement Disorder Society criteria and underwent periodic structured sleep, motor, cognitive, autonomic and olfactory testing. We used linear mixed-effect modelling to estimate annual rates of clinical marker progression stratified by disease subtype, including prodromal Parkinson's disease and prodromal dementia with Lewy bodies. In addition, we calculated sample size requirements to demonstrate slowing of progression under different anticipated treatment effects. Overall, 1160 subjects were followed over an average of 3.3 ± 2.2 years. Among clinical variables assessed continuously, motor variables tended to progress faster and required the lowest sample sizes, ranging from 151-560 per group (at 50% drug efficacy and 2-year follow-up). By contrast, cognitive, olfactory, and autonomic variables showed modest progression with higher variability, resulting in high sample sizes. The most efficient design was a time-to-event analysis using combined milestones of motor and cognitive decline, estimating 117 per group at 50% drug efficacy and 2-year trial duration. Finally, while phenoconverters showed overall greater progression than non-converters in motor, olfactory, cognitive, and certain autonomic markers, the only robust difference in progression between Parkinson's disease and dementia with Lewy bodies phenoconverters was in cognitive testing. This large multicenter study demonstrates the evolution of motor and non-motor manifestations in prodromal synucleinopathy. These findings provide optimized clinical endpoints and sample size estimates to inform future neuroprotective trials.
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Affiliation(s)
- Stephen Joza
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease Centre, University of Oxford, UK
| | - Ki-Young Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dieter Kunz
- Clinic for Sleep & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Ambra Stefani
- Medical University Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mya C Schiess
- Department of Neurology, The University of Texas Health Science Center at Houston, Texas, USA
| | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jee-Young Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | | | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Laurène Leclair-Visonneau
- Department of Clinical Neurophysiology, CHU de Nantes, Nantes, France.,Nantes Université, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
| | - Wolfgang H Oertel
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany.,Institute for Neurogenomics, Helmholtz Center for Health and Environment, München-Neuherberg, Germany
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Friederike Sixel-Döring
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany.,Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
| | - Valérie Cochen De Cock
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, 34090 Montpellier, France.,Department of Neurology and Sleep, Beau Soleil Clinic, Montpellier, France
| | - Claudio Liguori
- Sleep Medicine Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Monica Puligheddu
- Sleep Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessandra Nicoletti
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Claudio L A Bassetti
- Department of Neurology, University Hospital Bern (Inselspital), 3010, Bern, Switzerland
| | - Jitka Bušková
- National Institute of Mental Health, Klecany, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061, Montpellier, F-34093 Cedex 5 France
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS. Via Conte Ruggero 73, 94018, Troina, Italy
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Michael Lawton
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, UK
| | - Han-Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Frederik Bes
- Clinic for Sleep & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Birgit Högl
- Medical University Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Karel Šonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Giuseppe Fiamingo
- Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mattioli Pietro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa
| | - Maria Lorena Lavadia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessika Suescun
- Department of Neurology, The University of Texas Health Science Center at Houston, Texas, USA
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sara Marelli
- Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy
| | - Kaylena Ehgoetz Martens
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Annette Janzen
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Brit Mollenhauer
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany.,Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
| | - Mariana Fernandes
- Sleep Medicine Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Yuanyuan Li
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Michela Figorilli
- Sleep Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Calogero Edoardo Cicero
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Carolin Schaefer
- Department of Neurology, University Hospital Bern (Inselspital), 3010, Bern, Switzerland
| | - Lily Guiraud
- Sleep Unit, Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061, Montpellier, F-34093 Cedex 5 France
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS. Via Conte Ruggero 73, 94018, Troina, Italy.,Department of Surgery and Medical-Surgical Specialties, University of Catania. Via Santa Sofia 78, 95123, Catania, Italy
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Abubaker Ibrahim
- Medical University Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Trenkwalder
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany.,Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Amelie Pelletier
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
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25
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Palazzo A, Ciccarese C, Iacovelli R, Cannizzaro MC, Stefani A, Salvatore L, Bria E, Tortora G. Major adverse cardiac events and cardiovascular toxicity with PARP inhibitors-based therapy for solid tumors: a systematic review and safety meta-analysis. ESMO Open 2023; 8:101154. [PMID: 36893518 PMCID: PMC10163166 DOI: 10.1016/j.esmoop.2023.101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Poly(ADP-ribose) polymerase (PARP) inhibitors (PARPi) provided significant antitumor activity in various tumors, mainly carrying deleterious mutations of BRCA1/BRCA2 genes. Only few data are available regarding the cardiac and vascular safety profile of this drug class. We carried out a meta-analysis for assessing the incidence and relative risk (RR) of major adverse cardiovascular events (MACEs), hypertension, and thromboembolic events in patients with solid tumors treated with PARPi-based therapy. METHODS Prospective studies were identified by searching the Medline/PubMed, Cochrane Library, and ASCO Meeting abstracts. Data extraction was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) statement. Combined odds ratios (ORs), RRs, and 95% confidence intervals (CIs) were calculated using fixed- or random-effects methods, depending on studies heterogeneity. RevMan software for meta-analysis (v.5.2.3) was used to carry out statistical analyses. RESULTS Thirty-two studies were selected for the final analysis. The incidence of PARPi-related MACEs of any and high grade was 5.0% and 0.9%, respectively, compared with 3.6% and 0.9% in the control arms, corresponding to a significant increased risk of MACEs of any grade (Peto OR 1.62; P = 0.0009) but not of high grade (P = 0.49). The incidence of hypertension of any grade and high grade was 17.5% and 6.0% with PARPi, respectively, compared with 12.6% and 4.4% in the controls. Treatment with PARPi significantly increased the risk of hypertension of any grade (random-effects, RR = 1.53; P = 0.03) but not of high grade (random-effects, RR = 1.47; P = 0.09) compared with controls. Finally, PARPi-based therapies significantly increased the risk of thromboembolic events of any grade (Peto OR = 1.49, P = 0.004) and not of high grade (Peto OR = 1.31; P = 0.13) compared with controls. CONCLUSIONS PARPi-based therapy is associated with a significantly increased risk of MACEs, hypertension, and thromboembolic events of any grade compared with controls. The lack of a significant increased risk of high-grade events together with the absolute low incidence of these adverse events led not to consider routine cardiovascular monitoring as recommended in asymptomatic patients.
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Affiliation(s)
- A Palazzo
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - C Ciccarese
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - R Iacovelli
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - M C Cannizzaro
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Stefani
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Salvatore
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Bria
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Tortora
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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27
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Somerville EN, Krohn L, Yu E, Rudakou U, Senkevich K, Ruskey JA, Asayesh F, Ahmad J, Spiegelman D, Dauvilliers Y, Arnulf I, Hu MT, Montplaisir JY, Gagnon JF, Desautels A, Ibrahim A, Stefani A, Hogl B, Gigli GL, Valente M, Janes F, Bernardini A, Dusek P, Sonka K, Kemlink D, Plazzi G, Antelmi E, Biscarini F, Mollenhauer B, Trenkwalder C, Sixel-Doring F, Figorilli M, Puligheddu M, De Cock VC, Ferini-Strambi L, Heibreder A, Monaca CC, Abril B, Dijkstra F, Viaene M, Boeve BF, Postuma RB, Rouleau GA, Gan-Or Z. NPC1 variants are not associated with Parkinson’s disease, REM-sleep behaviour disorder or Dementia with Lewy bodies in European cohorts. Neurobiol Aging 2023; 127:94-98. [PMID: 37032242 DOI: 10.1016/j.neurobiolaging.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
NPC1 encodes a lysosomal protein involved in cholesterol transport. Biallelic mutations in this gene may lead to Niemann-Pick disease type C (NPC), a lysosomal storage disorder. The role of NPC1 in alpha synucleinopathies is still unclear, as different genetic, clinical, and pathological studies have reported contradictory results. This study aimed to evaluate the association of NPC1 variants with the synucleinopathies Parkinson's disease (PD), dementia with Lewy bodies (DLB), and rapid eye movement-sleep behavior disorder (RBD). We analyzed common and rare variants from 3 cohorts of European descent: 1084 RBD cases and 2945 controls, 2852 PD cases and 1686 controls, and 2610 DLB cases and 1920 controls. Logistic regression models were used to assess common variants while optimal sequence Kernel association tests were used to assess rare variants, both adjusted for sex, age, and principal components. No variants were associated with any of the synucleinopathies, supporting that common and rare NPC1 variants do not play an important role in alpha synucleinopathies.
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28
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Heidbreder A, Trenkwalder C, Bachmann CG, Bartl M, Fulda S, Habersack L, Maihöfner C, Mathis J, Muntean L, Schneider B, Stefani A, Paulus J, Young P. Restless Legs Syndrom. Somnologie 2023. [DOI: 10.1007/s11818-023-00399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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29
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Cesari M, Egger K, Stefani A, Bergmann M, Ibrahim A, Brandauer E, Högl B, Heidbreder A. Differentiation of central disorders of hypersomnolence with manual and artificial-intelligence-derived polysomnographic measures. Sleep 2023; 46:6862127. [PMID: 36455881 DOI: 10.1093/sleep/zsac288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Differentiation of central disorders of hypersomnolence (DOH) is challenging but important for patient care. This study aimed to investigate whether biomarkers derived from sleep structure evaluated both by manual scoring as well as with artificial intelligence (AI) algorithms allow distinction of patients with different DOH. We included video-polysomnography data of 40 narcolepsy type 1 (NT1), 26 narcolepsy type 2 (NT2), 23 patients with idiopathic hypersomnia (IH) and 54 participants with subjective excessive daytime sleepiness (sEDS). Sleep experts manually scored sleep stages. A previously validated AI algorithm was employed to obtain automatic hypnograms and hypnodensity graphs (where each epoch is represented as a mixture of sleep stage probabilities). One-thousand-three features describing sleep architecture and instability were extracted from manual/automatic hypnogram and hypnodensity graphs. After feature selection, random forest classifiers were trained and tested in a 5-fold-cross-validation scheme to distinguish groups pairwise (NT1-vs-NT2, NT1-vs-IH, …) and single groups from the pooled remaining ones (NT1-vs-rest, NT2-vs-rest,…). The accuracy/F1-score values obtained in the test sets were: 0.74 ± 0.04/0.79 ± 0.05 (NT1-vs-NT2), 0.89 ± 0.09/0.91 ± 0.08 (NT1-vs-IH), 0.93 ± 0.06/0.91 ± 0.07 (NT1-vs-sEDS), 0.88 ± 0.04/0.80 ± 0.07 (NT1-vs-rest), 0.65 ± 0.10/0.70 ± 0.09 (NT2-vs-IH), 0.72 ± 0.12/0.60 ± 0.10 (NT2-vs-sEDS), 0.54 ± 0.19/0.38 ± 0.13 (NT2-vs-rest), 0.57 ± 0.11/0.35 ± 0.18 (IH-vs-sEDS), 0.71 ± 0.08/0.35 ± 0.10 (IH-vs-rest) and 0.76 ± 0.08/0.71 ± 0.13 (sEDS-vs-rest). The results confirm previous findings on sleep instability in patients with NT1 and show that combining manual and automatic AI-based sleep analysis could be useful for better distinction of NT2 from IH, but no precise sleep biomarker of NT2 or IH could be identified. Validation in a larger and multi-centric cohort is needed to confirm these findings.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kristin Egger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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30
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Cesari M, Heidbreder A, St Louis EK, Sixel-Döring F, Bliwise DL, Baldelli L, Bes F, Fantini ML, Iranzo A, Knudsen-Heier S, Mayer G, McCarter S, Nepozitek J, Pavlova M, Provini F, Santamaria J, Sunwoo JS, Videnovic A, Högl B, Jennum P, Christensen JAE, Stefani A. Polysomnographic diagnosis of REM sleep behavior disorder: a change is needed. Sleep 2023; 46:6909026. [PMID: 36519899 DOI: 10.1093/sleep/zsac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Research, Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| | - Friederike Sixel-Döring
- Paracelsus Elena Klinik, Kassel, Germany.,Department of Neurology, Philipps-University, Marburg, Germany
| | - Donald L Bliwise
- Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Frederik Bes
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Maria Livia Fantini
- NPsy-Sydo, Clermont- Ferrand University Hospital, Neurology Department, Université Clermont Auvergne, Clermont- Ferrand, France
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Stine Knudsen-Heier
- Norwegian Center of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare disorders, Oslo University Hospital, Norway
| | - Geert Mayer
- Department of Neurology, Philipps-University, Marburg, Germany.,Hephata Klinik, Schwalmstadt, Germany
| | - Stuart McCarter
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Denmark
| | - Julie A E Christensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Denmark.,Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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31
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Eckhardt C, Fanciulli A, Högl B, Heidbreder A, Eschlböck S, Raccagni C, Krismer F, Leys F, Kiechl S, Ransmayr G, Frauscher B, Seppi K, Wenning G, Stefani A. Analysis of sleep, daytime sleepiness, and autonomic function in multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med 2023; 19:63-71. [PMID: 36004744 PMCID: PMC9806784 DOI: 10.5664/jcsm.10268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Sleep disorders, daytime sleepiness, and autonomic dysfunction are commonly reported among patients with multiple system atrophy and Parkinson disease (PD). We aimed to assess sleep and autonomic function in these patients to evaluate the relationships between sleep disorders, excessive daytime sleepiness, and autonomic function. METHODS Twenty patients with multiple system atrophy (n = 7) and PD (n = 13) underwent clinical assessment including questionnaires for autonomic function and sleep. Cardiovascular autonomic function tests and 2-night video-polysomnography were followed by administration of the Multiple Sleep Latency Test. Rapid eye movement sleep without atonia was quantified in the chin, flexor digitorum superficialis, tibial anterior, and sternocleidomastoid muscles. RESULTS Rapid eye movement sleep behavior disorder was associated with orthostatic hypotension (P = .017) and constipation (P = .019) in PD. Patients with orthostatic hypotension had higher rapid eye movement sleep without atonia indices than those without orthostatic hypotension (P < .001). The Sleep Innsbruck Barcelona rapid eye movement sleep without atonia index ("any" chin and/or flexor digitorum superficialis) correlated with systolic/diastolic blood pressure fall upon tilt-table examination in patients with multiple system atrophy (P < .05) and with gastrointestinal (P = .010), urinary (P = .022), and total Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction scores (P = .006) in all patients. Patients with a pathological deep breathing ratio showed higher Sleep Innsbruck Barcelona indices (P = .031). Objective daytime sleepiness was exclusively present in PD (P = .034) and correlated with levodopa-equivalent dosage (P = .031). CONCLUSIONS The relationship of autonomic dysfunction with rapid eye movement sleep without atonia in PD and multiple system atrophy is accounted for by shared brainstem neuropathology and likely identifies patients in a more advanced stage of disease. Excessive daytime sleepiness is found exclusively in PD and may be secondary to levodopa treatment and not related to α-synuclein disease. CITATION Eckhardt C, Fanciulli A, Högl B, et al. Analysis of sleep, daytime sleepiness, and autonomic function and multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med. 2023;19(1):63-71.
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Affiliation(s)
- Christine Eckhardt
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Sabine Eschlböck
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Cecilia Raccagni
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Neurology, Regional Hospital of Bolzano, Bolzano, Italy
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Leys
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | | | - Birgit Frauscher
- Analytical Neurophysiology Lab and Epilepsy Program, Montreal Neurological Institute and Hospital, McGill University, Montreal H3A 2B4, Quebec, Canada
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gregor Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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32
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Krohn L, Heilbron K, Blauwendraat C, Reynolds RH, Yu E, Senkevich K, Rudakou U, Estiar MA, Gustavsson EK, Brolin K, Ruskey JA, Freeman K, Asayesh F, Chia R, Arnulf I, Hu MTM, Montplaisir JY, Gagnon JF, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Högl B, Stefani A, Ibrahim A, Šonka K, Kemlink D, Oertel W, Janzen A, Plazzi G, Biscarini F, Antelmi E, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel-Döring F, Cochen De Cock V, Monaca CC, Heidbreder A, Ferini-Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Scholz SW, Ryten M, Bandres-Ciga S, Noyce A, Cannon P, Pihlstrøm L, Nalls MA, Singleton AB, Rouleau GA, Postuma RB, Gan-Or Z. Genome-wide association study of REM sleep behavior disorder identifies polygenic risk and brain expression effects. Nat Commun 2022; 13:7496. [PMID: 36470867 PMCID: PMC9722930 DOI: 10.1038/s41467-022-34732-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/03/2022] [Indexed: 12/11/2022] Open
Abstract
Rapid-eye movement (REM) sleep behavior disorder (RBD), enactment of dreams during REM sleep, is an early clinical symptom of alpha-synucleinopathies and defines a more severe subtype. The genetic background of RBD and its underlying mechanisms are not well understood. Here, we perform a genome-wide association study of RBD, identifying five RBD risk loci near SNCA, GBA, TMEM175, INPP5F, and SCARB2. Expression analyses highlight SNCA-AS1 and potentially SCARB2 differential expression in different brain regions in RBD, with SNCA-AS1 further supported by colocalization analyses. Polygenic risk score, pathway analysis, and genetic correlations provide further insights into RBD genetics, highlighting RBD as a unique alpha-synucleinopathy subpopulation that will allow future early intervention.
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Affiliation(s)
- Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | | | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Regina H Reynolds
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
| | - Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Konstantin Senkevich
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Uladzislau Rudakou
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Mehrdad A Estiar
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Emil K Gustavsson
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Kajsa Brolin
- Lund University, Translational Neurogenetics Unit, Department of Experimental Medical Science, Lund, Sweden
| | - Jennifer A Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Kathryn Freeman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Ruth Chia
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Isabelle Arnulf
- Sleep Disorders Unit, Pitié Salpêtrière Hospital, APHP-Sorbonne, Paris Brain Insitute and Sorbonne University, Paris, France
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alex Desautels
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Institute Neuroscience Montpellier Inserm, Montpellier, France
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Wolfgang Oertel
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Annette Janzen
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps-University, Marburg, Germany
- Paracelsus-Elena-Klinik, Kassel, Germany
| | - Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France
- EuroMov Digital Health in Motion, University of Montpellier IMT Mines Ales, Montpellier, France
| | - Christelle Charley Monaca
- University Lille North of France, Department of Clinical Neurophysiology and Sleep Center, CHU Lille, Lille, France
| | - Anna Heidbreder
- Institute of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Femke Dijkstra
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
| | - Beatriz Abril
- Sleep disorder Unit, Carémeau Hospital, University Hospital of Nîmes, Nîmes, France
| | | | | | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Mina Ryten
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Institute of Neurology, London, UK
| | | | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mike A Nalls
- Data Tecnica International, Glen Echo, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ronald B Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada.
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
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Röthenbacher A, Cesari M, Doppler CEJ, Okkels N, Willemsen N, Sembowski N, Seger A, Lindner M, Brune C, Stefani A, Högl B, Bialonski S, Borghammer P, Fink GR, Schober M, Sommerauer M. RBDtector: an open-source software to detect REM sleep without atonia according to visual scoring criteria. Sci Rep 2022; 12:20886. [PMID: 36463304 PMCID: PMC9719467 DOI: 10.1038/s41598-022-25163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/25/2022] [Indexed: 12/07/2022] Open
Abstract
REM sleep without atonia (RSWA) is a key feature for the diagnosis of rapid eye movement (REM) sleep behaviour disorder (RBD). We introduce RBDtector, a novel open-source software to score RSWA according to established SINBAR visual scoring criteria. We assessed muscle activity of the mentalis, flexor digitorum superficialis (FDS), and anterior tibialis (AT) muscles. RSWA was scored manually as tonic, phasic, and any activity by human scorers as well as using RBDtector in 20 subjects. Subsequently, 174 subjects (72 without RBD and 102 with RBD) were analysed with RBDtector to show the algorithm's applicability. We additionally compared RBDtector estimates to a previously published dataset. RBDtector showed robust conformity with human scorings. The highest congruency was achieved for phasic and any activity of the FDS. Combining mentalis any and FDS any, RBDtector identified RBD subjects with 100% specificity and 96% sensitivity applying a cut-off of 20.6%. Comparable performance was obtained without manual artefact removal. RBD subjects also showed muscle bouts of higher amplitude and longer duration. RBDtector provides estimates of tonic, phasic, and any activity comparable to human scorings. RBDtector, which is freely available, can help identify RBD subjects and provides reliable RSWA metrics.
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Affiliation(s)
- Annika Röthenbacher
- grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-1), Forschungszentrum Jülich, Jülich, Germany
| | - Matteo Cesari
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christopher E. J. Doppler
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany
| | - Niels Okkels
- grid.154185.c0000 0004 0512 597XDepartment of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Neurology, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nele Willemsen
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nora Sembowski
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Aline Seger
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany
| | - Marie Lindner
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Corinna Brune
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ambra Stefani
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Bialonski
- grid.434081.a0000 0001 0698 0538Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Jülich, Germany ,grid.434081.a0000 0001 0698 0538Institute for Data-Driven Technologies, FH Aachen University of Applied Sciences, Jülich, Germany
| | - Per Borghammer
- grid.154185.c0000 0004 0512 597XDepartment of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Gereon R. Fink
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany
| | - Martin Schober
- grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-1), Forschungszentrum Jülich, Jülich, Germany
| | - Michael Sommerauer
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany ,grid.154185.c0000 0004 0512 597XDepartment of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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Stefani A. Low specificity of screening questionnaires for REM sleep behavior disorder. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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van der Veen S, Caviness JN, Dreissen YE, Ganos C, Ibrahim A, Koelman JH, Stefani A, Tijssen MA. Myoclonus and other jerky movement disorders. Clin Neurophysiol Pract 2022; 7:285-316. [PMID: 36324989 PMCID: PMC9619152 DOI: 10.1016/j.cnp.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Myoclonus and other jerky movements form a large heterogeneous group of disorders. Clinical neurophysiology studies can have an important contribution to support diagnosis but also to gain insight in the pathophysiology of different kind of jerks. This review focuses on myoclonus, tics, startle disorders, restless legs syndrome, and periodic leg movements during sleep. Myoclonus is defined as brief, shock-like movements, and subtypes can be classified based the anatomical origin. Both the clinical phenotype and the neurophysiological tests support this classification: cortical, cortical-subcortical, subcortical/non-segmental, segmental, peripheral, and functional jerks. The most important techniques used are polymyography and the combination of electromyography-electroencephalography focused on jerk-locked back-averaging, cortico-muscular coherence, and the Bereitschaftspotential. Clinically, the differential diagnosis of myoclonus includes tics, and this diagnosis is mainly based on the history with premonitory urges and the ability to suppress the tic. Electrophysiological tests are mainly applied in a research setting and include the Bereitschaftspotential, local field potentials, transcranial magnetic stimulation, and pre-pulse inhibition. Jerks due to a startling stimulus form the group of startle syndromes. This group includes disorders with an exaggerated startle reflex, such as hyperekplexia and stiff person syndrome, but also neuropsychiatric and stimulus-induced disorders. For these disorders polymyography combined with a startling stimulus can be useful to determine the pattern of muscle activation and thus the diagnosis. Assessment of symptoms in restless legs syndrome and periodic leg movements during sleep can be performed with different validated scoring criteria with the help of electromyography.
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Affiliation(s)
- Sterre van der Veen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - John N. Caviness
- Department of Neurology, Mayo Clinic Arizona, Movement Neurophysiology Laboratory, Scottsdale, AZ, USA
| | - Yasmine E.M. Dreissen
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christos Ganos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes H.T.M. Koelman
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Corresponding author at: Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands.
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36
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Khachatryan SG, Ferri R, Fulda S, Garcia-Borreguero D, Manconi M, Muntean ML, Stefani A. Restless legs syndrome: Over 50 years of European contribution. J Sleep Res 2022; 31:e13632. [PMID: 35808955 PMCID: PMC9542244 DOI: 10.1111/jsr.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterised by an urge to move the limbs with a circadian pattern (occurring in the evening/at night), more prominent at rest, and relieved with movements. RLS is one of the most prevalent sleep disorders, occurring in 5%-10% of the European population. Thomas Willis first described RLS clinical cases already in the 17th century, and Karl-Axel Ekbom described the disease as a modern clinical entity in the 20th century. Despite variable severity, RLS can markedly affect sleep (partly through the presence of periodic leg movements) and quality of life, with a relevant socio-economic impact. Thus, its recognition and treatment are essential. However, screening methods present limitations and should be improved. Moreover, available RLS treatment options albeit providing sustained relief to many patients are limited in number. Additionally, the development of augmentation with dopamine agonists represents a major treatment problem. A better understanding of RLS pathomechanisms can bring to light novel treatment possibilities. With emerging new avenues of research in pharmacology, imaging, genetics, and animal models of RLS, this is an interesting and constantly growing field of research. This review will update the reader on the current state of RLS clinical practice and research, with a special focus on the contribution of European researchers.
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Affiliation(s)
- Samson G Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia.,Sleep Disorders Center, Somnus Neurology Clinic, Yerevan, Armenia
| | | | - Stephany Fulda
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | | | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Maria-Lucia Muntean
- Center for Parkinson's Disease and Movement Disorders, Paracelsus-Elena Klinik, Kassel, Germany
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Kohn B, Ruzicka L, Hogl B, Ibrahim A, Garn H, Heidbreder A, Bergmann M, Brandauer E, Holzknecht E, Stefani A, Cesari M. TeaSpam: A Novel Method of TEmporal And SPAtial Movement Encoding during Sleep. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:4222-4225. [PMID: 36085969 DOI: 10.1109/embc48229.2022.9871521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Movements during sleep characterize sleep disorders, which can disturb sleep or its onset, impacting sleep quantity and quality. Video-polysomnography is the current gold standard to assess movements during sleep, but its availability is limited. Using data recorded with a 3D time of flight sensor, we developed a novel method of encoding temporal and spatial information of automatically identified movements during sleep. In a cohort of 20 insomnia patients and 18 controls, we showed that this novel method holds important information able to discriminate the groups. Future studies will explore the methodology in the context of other sleep disorders.
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Beliveau V, Stefani A, Birkl C, Kremser C, Gizewski ER, Högl B, Scherfler C. Revisiting brain iron deficiency in restless legs syndrome using magnetic resonance imaging. Neuroimage Clin 2022; 34:103024. [PMID: 35500370 PMCID: PMC9065426 DOI: 10.1016/j.nicl.2022.103024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/07/2022] [Accepted: 04/24/2022] [Indexed: 12/19/2022]
Abstract
Increased iron in RLS was found in the caudate, putamen and red nucleus. A meta-analysis revealed no significant evidence of reduced iron in RLS as assessed by MRI. Evidence suggestive of publication bias for results on the substantia nigra was found. Our results support the view that brain iron mobilization or homeostasis is impaired in RLS.
Study objectives Studies on brain iron content in restless legs syndrome (RLS) using magnetic resonance imaging (MRI) are heterogeneous. In this study, we sought to leverage the availability of a large dataset including a range of iron-sensitive MRI techniques to reassess the association between brain iron content and RLS with added statistical power and to compare these results to previous studies. Methods The relaxation rates R2, R2′, and R2* and quantitative susceptibility are MRI parameters strongly correlated to iron content. In general, these parameters are sensitive to magnetic field variations caused by iron particles. These parameters were quantified within iron-rich brain regions using a fully automatized approach in a cohort of 72 RLS patients and individually age and gender-matched healthy controls identified from an existing dataset acquired at the Sleep Laboratory of the Department of Neurology, Medical University of Innsbruck. 3 T-MRI measures were corrected for age and volume of the segmented brain nuclei and results were compared with previous findings in a meta-analysis. Results In our cohort, RLS patients had increased R2* signal in the caudate and increased quantitative susceptibility signal in the putamen and the red nucleus compared to controls, suggesting increased iron content in these areas. The meta-analysis revealed no significant pooled effect across all brain regions. Furthermore, potential publication bias was identified for the substantia nigra. Conclusions Normal and increased iron content of subcortical brain areas detected in this study is not in line with the hypothesis of reduced brain iron storage, but favors CSF investigations and post mortem studies indicating alteration of brain iron mobilization and homeostasis in RLS.
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Affiliation(s)
- Vincent Beliveau
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria; Medical University of Innsbruck, Neuroimaging Research Core Facility, Innsbruck, Austria
| | - Ambra Stefani
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Christoph Birkl
- Medical University of Innsbruck, Department of Neuroradiology, Innsbruck, Austria
| | - Christian Kremser
- Medical University of Innsbruck, Department of Radiology, Innsbruck, Austria
| | - Elke R Gizewski
- Medical University of Innsbruck, Department of Neuroradiology, Innsbruck, Austria; Medical University of Innsbruck, Department of Radiology, Innsbruck, Austria
| | - Birgit Högl
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Christoph Scherfler
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria; Medical University of Innsbruck, Neuroimaging Research Core Facility, Innsbruck, Austria.
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39
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Sosero YL, Yu E, Estiar MA, Krohn L, Mufti K, Rudakou U, Ruskey JA, Asayesh F, Laurent SB, Spiegelman D, Trempe JF, Quinnell TG, Oscroft N, Arnulf I, Montplaisir JY, Gagnon JF, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Sonka K, Kemlink D, Oertel W, Janzen A, Plazzi G, Antelmi E, Biscarini F, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel-Döring F, Cochen De Cock V, Monaca CC, Heidbreder A, Ferini-Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Postuma RB, Rouleau GA, Ibrahim A, Stefani A, Högl B, Hu MTM, Gan-Or Z. Rare PSAP Variants and Possible Interaction with GBA in REM Sleep Behavior Disorder. J Parkinsons Dis 2022; 12:333-340. [PMID: 34690151 DOI: 10.3233/jpd-212867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND PSAP encodes saposin C, the co-activator of glucocerebrosidase, encoded by GBA. GBA mutations are associated with idiopathic/isolated REM sleep behavior disorder (iRBD), a prodromal stage of synucleinopathy. OBJECTIVE To examine the role of PSAP mutations in iRBD. METHODS We fully sequenced PSAP and performed Optimized Sequence Kernel Association Test in 1,113 iRBD patients and 2,324 controls. We identified loss-of-function (LoF) mutations, which are very rare in PSAP, in three iRBD patients and none in controls (uncorrected p = 0.018). RESULTS Two variants were stop mutations, p.Gln260Ter and p.Glu166Ter, and one was an in-frame deletion, p.332_333del. All three mutations have a deleterious effect on saposin C, based on in silico analysis. In addition, the two carriers of p.Glu166Ter and p.332_333del mutations also carried a GBA variant, p.Arg349Ter and p.Glu326Lys, respectively. The co-occurrence of these extremely rare PSAP LoF mutations in two (0.2%) GBA variant carriers in the iRBD cohort, is unlikely to occur by chance (estimated co-occurrence in the general population based on gnomAD data is 0.00035%). Although none of the three iRBD patients with PSAP LoF mutations have phenoconverted to an overt synucleinopathy at their last follow-up, all manifested initial signs suggestive of motor dysfunction, two were diagnosed with mild cognitive impairment and all showed prodromal clinical markers other than RBD. Their probability of prodromal PD, according to the Movement Disorder Society research criteria, was 98% or more. CONCLUSION These results suggest a possible role of PSAP variants in iRBD and potential genetic interaction with GBA, which requires additional studies.
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Affiliation(s)
- Yuri L Sosero
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Mehrdad A Estiar
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Kheireddin Mufti
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Uladzislau Rudakou
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jennifer A Ruskey
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Farnaz Asayesh
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Sandra B Laurent
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Dan Spiegelman
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Jean-François Trempe
- Department of Pharmacology & Therapeutics and Centre de Recherche en Biologie Structurale, McGill University, Montréal, Québec, Canada
| | | | | | - Isabelle Arnulf
- Sleep Disorders Unit, Sorbonne University, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Alex Desautels
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Gian Luigi Gigli
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Francesco Janes
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
| | - Annette Janzen
- Department of Neurology, Philipps University, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Neurosciences, Neurology Unit, Movement Disorders Division, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps University, Marburg, Germany.,Paracelsus-Elena-Klinik, Kassel, Germany
| | - Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France.,EuroMov, University of Montpellier, Montpellier, France
| | - Christelle Charley Monaca
- Department of Clinical Neurophysiology and Sleep Center, University Lille North of France, CHU Lille, Lille, France
| | - Anna Heidbreder
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Femke Dijkstra
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium.,Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium.,Department of Neurology, University Hospital Antwerp, Edegem, Antwerp, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium.,Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
| | - Beatriz Abril
- Sleep disorder Unit, Carémeau Hospital, University Hospital of Nîmes, France
| | | | - Ronald B Postuma
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Abubaker Ibrahim
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele T M Hu
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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41
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Beliveau V, Birkl C, Stefani A, Gizewski ER, Scherfler C. HFP-QSMGAN: QSM from homodyne-filtered phase images. Magn Reson Med 2022; 88:1255-1262. [PMID: 35381109 PMCID: PMC9323427 DOI: 10.1002/mrm.29260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Homodyne filtering is a standard preprocessing step in the estimation of SWI. Unfortunately, SWI is not quantitative, and QSM cannot be accurately estimated from filtered phase images. Compared with gradient-echo sequences suitable for computing QSM, SWI is more readily available and is often the only susceptibility-sensitive sequence acquired in the clinical setting. In this project, we aimed to quantify susceptibility from the homodyne-filtered phase (HFP), acquired for computing susceptibility-weighted images, using convolutional neural networks to solve the compounded problem of (1) computing the solution to the inverse dipole problem, and (2) compensating for the effects of the homodyne filtering. METHODS Two convolutional neural networks, the U-Net and a modified QSMGAN architecture (HFP-QSMGAN), were trained to predict QSM maps at different TEs from HFP images. The QSM maps were quantified from a gradient-echo sequence acquired in the same individuals using total generalized variation (TGV)-QSM. The QSM maps estimated directly from the HFP were also included for comparison. Voxel-wise predictions and, importantly, regional predictions of susceptibility with adjustment to a reference region, were compared. RESULTS Our results indicate that the U-Net model provides more accurate voxel-wise predictions of susceptibility compared with HFP-QSMGAN and HFP-QSM. However, regional estimates of susceptibility predicted by HFP-QSMGAN are more strongly correlated with the values from TGV-QSM compared with those of U-Net and HFP-QSM. CONCLUSION Accurate prediction of susceptibility can be achieved from filtered SWI phase using convolutional neural networks.
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Affiliation(s)
- Vincent Beliveau
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Birkl
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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42
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Tilch E, Schormair B, Zhao C, Högl B, Stefani A, Berger K, Trenkwalder C, Bachmann CG, Hornyak M, Fietze I, Müller-Nurasyid M, Peters A, Herms S, Nöthen MM, Müller-Myhsok B, Oexle K, Winkelmann J. Exomechip-based rare variant association study in restless legs syndrome. Sleep Med 2022; 94:26-30. [DOI: 10.1016/j.sleep.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
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Cesari M, Heidbreder A, St Louis EK, Sixel-Döring F, Bliwise DL, Baldelli L, Bes F, Fantini ML, Iranzo A, Knudsen-Heier S, Mayer G, McCarter S, Nepozitek J, Pavlova M, Provini F, Santamaria J, Sunwoo JS, Videnovic A, Högl B, Jennum P, Christensen JAE, Stefani A. Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: guidelines from the International RBD Study Group. Sleep 2022; 45:6409886. [PMID: 34694408 DOI: 10.1093/sleep/zsab257] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Video-polysomnography (v-PSG) is essential for diagnosing rapid eye movement (REM) sleep behavior disorder (RBD). Although there are current American Academy of Sleep Medicine standards to diagnose RBD, several aspects need to be addressed to achieve harmonization across sleep centers. Prodromal RBD is a stage in which symptoms and signs of evolving RBD are present, but do not yet meet established diagnostic criteria for RBD. However, the boundary between prodromal and definite RBD is still unclear. As a common effort of the Neurophysiology Working Group of the International RBD Study Group, this manuscript addresses the need for comprehensive and unambiguous v-PSG recommendations to diagnose RBD and identify prodromal RBD. These include: (1) standardized v-PSG technical settings; (2) specific considerations for REM sleep scoring; (3) harmonized methods for scoring REM sleep without atonia; (4) consistent methods to analyze video and audio recorded during v-PSGs and to classify movements and vocalizations; (5) clear v-PSG guidelines to diagnose RBD and identify prodromal RBD. Each section follows a common template: The current recommendations and methods are presented, their limitations are outlined, and new recommendations are described. Finally, future directions are presented. These v-PSG recommendations are intended for both practicing clinicians and researchers. Classification and quantification of motor events, RBD episodes, and vocalizations are however intended for research purposes only. These v-PSG guidelines will allow collection of homogeneous data, providing objective v-PSG measures and making future harmonized multicentric studies and clinical trials possible.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Research, Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| | - Friederike Sixel-Döring
- Paracelsus Elena Klinik, Kassel, Germany.,Department of Neurology, Philipps-University, Marburg, Germany
| | - Donald L Bliwise
- Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Frederik Bes
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Maria Livia Fantini
- NPsy-Sydo, Clermont-Ferrand University Hospital, Neurology Department, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Stine Knudsen-Heier
- Norwegian Center of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare disorders, Oslo University Hospital, Oslo, Norway
| | - Geert Mayer
- Department of Neurology, Philipps-University, Marburg, Germany.,Department of Neurology, Hephata Klinik, Schwalmstadt, Germany
| | - Stuart McCarter
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Denmark
| | - Julie A E Christensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Denmark.,Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Bergmann M, Brandauer E, Stefani A, Heidbreder A, Unterberger I, Högl B. The additional diagnostic benefits of performing both video-polysomnography and prolonged video-EEG-monitoring: when and why. Clin Neurophysiol Pract 2022; 7:98-102. [PMID: 35330982 PMCID: PMC8938868 DOI: 10.1016/j.cnp.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022] Open
Abstract
Video-polysomnography (VPSG) and prolonged video-EEG-monitoring (pVEEG-M) are indicated for different suspected diagnoses. Here, we report on 109 patients who underwent both, VPSG and pVEEG-M, within a 10 year period. Both examinations were performed in case of comorbidities, to achieve a final diagnosis or to refute differential diagnoses.
Objective Video-polysomnography (VPSG) and prolonged video-EEG-monitoring (pVEEG-M) are neurophysiological investigation modalities. Depending on indication either is performed, but occasionally patients undergo both (during the same or separate stays). We sought to assess the reasons and potential benefits of dual diagnostic assessments with both modalities. Methods A retrospective chart-review was performed to identify patients who underwent both VPSG and pVEEG-M during the 10 year period between 2007 and 2017. One-hundred-nine patients were identified who had undergone both studies. Patients were grouped according to indication and outcome. Results One-hundred-nine patients had both, a VPSG and pVEEG-M, in 62 (56.9%) the studies were performed because of separate diagnoses independent from each other. In 47 patients (43.1%) investigation with both modalities was needed to clarify the suspected diagnosis or to refute differential diagnoses. Out of these 47, 11 (10.1% of the whole group) arrived a new final diagnosis whereas in 36 (33%) the primary diagnosis was corroborated with the second modality. Conclusions In the majority of cases VPSG plus pVEEG-M were indicated to diagnose or monitor different comorbid diseases (e.g. sleep-related breathing disorder and epilepsy). In the other cases, performing both modalities was useful to achieve a higher diagnostic accuracy or to refute differential diagnoses. Significance VPSG and pVEEG-M are neurophysiological investigations which complement each other, especially in case of two different comorbid diseases in a single patient, to rule out differential diagnosis or when a higher diagnostic certainty is seeked.
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Zhang H, Iranzo A, Högl B, Arnulf I, Ferini‐Strambi L, Manni R, Miyamoto T, Oertel WH, Dauvilliers Y, Ju Y, Puligheddu M, Sonka K, Pelletier A, Montplaisir JY, Stefani A, Ibrahim A, Frauscher B, Leu‐Semenescu S, Zucconi M, Terzaghi M, Miyamoto M, Janzen A, Figorilli M, Fantini ML, Postuma RB. Risk factors for phenoconversion in
REM
sleep behavior disorder. Ann Neurol 2022; 91:404-416. [DOI: 10.1002/ana.26298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Hui Zhang
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
- Department of Neurology McGill University, Montreal General Hospital Montreal Canada
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona IDIBAPS, CIBERNED Barcelona Spain
| | - Birgit Högl
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Isabelle Arnulf
- Sorbonne University, Paris Brain Institute and sleep disorder unit Pitie‐Salpetriere Hospital, APHP Paris France
| | | | | | - Tomoyuki Miyamoto
- Department of Neurology, Dokkyo Medical University Saitama Medical Center Saitama Japan
| | | | - Yves Dauvilliers
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061 Montpellier F‐34093 Cedex 5 France
| | - Yo‐EI Ju
- Washington University School of Medicine, Department of Neurology St. Louis Missouri USA
| | - Monica Puligheddu
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
| | - Karel Sonka
- Department of Neurology First Faculty of Medicine, Charles University and General University Hospital Prague Czech Republic
| | - Amélie Pelletier
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
- Department of Psychiatry University of Montreal Montreal Canada
| | - Ambra Stefani
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Abubaker Ibrahim
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Birgit Frauscher
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Smaranda Leu‐Semenescu
- Sorbonne University, Paris Brain Institute and sleep disorder unit Pitie‐Salpetriere Hospital, APHP Paris France
| | - Marco Zucconi
- Sleep Disorders Center Università Vita‐Salute San Raffaele Milan Italy
| | | | - Masayuki Miyamoto
- Department of Neurology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Annette Janzen
- Department of Neurology Philipps‐Universität Marburg Germany
| | - Michela Figorilli
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
| | - Maria L Fantini
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
- Department of Neurology Université d'Auvergne Clermont‐Ferrand France
| | - Ronald B Postuma
- Department of Neurology McGill University, Montreal General Hospital Montreal Canada
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
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Heim B, Ellmerer P, Stefani A, Bergmann M, Brandauer E, Seppi K, Högl B, Djamshidian A. Factors associated with augmentation in patients with restless legs syndrome. Eur J Neurol 2021; 29:1227-1231. [PMID: 34923723 PMCID: PMC9303546 DOI: 10.1111/ene.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
Abstract
Background and purpose Augmentation is a paradoxical reaction mainly to dopaminergic medication in patients with restless legs syndrome (RLS), but the exact pathomechanism remains unclear. The aim of this study was to identify factors associated with augmentation in RLS patients. Methods RLS patients with and without current or previous augmentation were recruited. Demographic characteristics, history of smoking, questionnaires for depression, alexithymia, and impulsivity, and RLS severity were obtained. Results We included 122 patients, of whom half had a history of augmentation. Patients with augmentation had a longer disease duration (p = 0.001), had higher RLS severity scores (p = 0.013), had higher levodopa equivalent doses (p < 0.001), had higher scores for alexithymia (p = 0.028), had higher prevalence of impulse control disorders (p < 0.001), more often had a history of smoking (p = 0.039), were more often currently smoking (p = 0.015), and had more average pack‐years (p = 0.016). Conclusions Here, we describe several factors commonly associated with augmentation in RLS. These may help clinicians to screen and treat patients carefully to avoid the challenging side effect of augmentation.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Ellmerer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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47
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Cesari M, Kohn B, Holzknecht E, Ibrahim A, Heidbreder A, Bergmann M, Brandauer E, Hogl B, Garn H, Stefani A. Automatic 3D Video Analysis of Upper and Lower Body Movements to Identify Isolated REM Sleep Behavior Disorder: A Pilot Study . Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:7050-7053. [PMID: 34892726 DOI: 10.1109/embc46164.2021.9630011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment, abnormal jerks and movements during REM sleep. Isolated RBD (iRBD) is recognized as the early stage of alpha-synucleinopathies, i.e. dementia with Lewy bodies, Parkinson's disease and multiple system atrophy. The certain diagnosis of iRBD requires video-polysomnography, evaluated by experts with time-consuming visual analyses. In this study, we propose automatic analysis of movements detected with 3D contactless video as a promising technology to assist sleep experts in the identification of patients with iRBD. By using automatically detected upper and lower body movements occurring during REM sleep with a duration between 4s and 5s, we could discriminate 20 iRBD patients from 24 patients with sleep-disordered breathing with an accuracy of 0.91 and F1-score of 0.90. This pilot study shows that 3D contactless video can be successfully used as a non-invasive technology to assist clinicians in identifying abnormal movements during REM sleep, and therefore to recognize patients with iRBD. Future investigations in larger cohorts are needed to validate the proposed technology and methodology.
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48
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Harding IH, Chopra S, Arrigoni F, Boesch S, Brunetti A, Cocozza S, Corben LA, Deistung A, Delatycki M, Diciotti S, Dogan I, Evangelisti S, França MC, Göricke SL, Georgiou-Karistianis N, Gramegna LL, Henry PG, Hernandez-Castillo CR, Hutter D, Jahanshad N, Joers JM, Lenglet C, Lodi R, Manners DN, Martinez ARM, Martinuzzi A, Marzi C, Mascalchi M, Nachbauer W, Pane C, Peruzzo D, Pisharady PK, Pontillo G, Reetz K, Rezende TJR, Romanzetti S, Saccà F, Scherfler C, Schulz JB, Stefani A, Testa C, Thomopoulos SI, Timmann D, Tirelli S, Tonon C, Vavla M, Egan GF, Thompson PM. Brain Structure and Degeneration Staging in Friedreich Ataxia: Magnetic Resonance Imaging Volumetrics from the ENIGMA-Ataxia Working Group. Ann Neurol 2021; 90:570-583. [PMID: 34435700 PMCID: PMC9292360 DOI: 10.1002/ana.26200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 01/24/2023]
Abstract
Objective Friedreich ataxia (FRDA) is an inherited neurological disease defined by progressive movement incoordination. We undertook a comprehensive characterization of the spatial profile and progressive evolution of structural brain abnormalities in people with FRDA. Methods A coordinated international analysis of regional brain volume using magnetic resonance imaging data charted the whole‐brain profile, interindividual variability, and temporal staging of structural brain differences in 248 individuals with FRDA and 262 healthy controls. Results The brainstem, dentate nucleus region, and superior and inferior cerebellar peduncles showed the greatest reductions in volume relative to controls (Cohen d = 1.5–2.6). Cerebellar gray matter alterations were most pronounced in lobules I–VI (d = 0.8), whereas cerebral differences occurred most prominently in precentral gyri (d = 0.6) and corticospinal tracts (d = 1.4). Earlier onset age predicted less volume in the motor cerebellum (rmax = 0.35) and peduncles (rmax = 0.36). Disease duration and severity correlated with volume deficits in the dentate nucleus region, brainstem, and superior/inferior cerebellar peduncles (rmax = −0.49); subgrouping showed these to be robust and early features of FRDA, and strong candidates for further biomarker validation. Cerebral white matter abnormalities, particularly in corticospinal pathways, emerge as intermediate disease features. Cerebellar and cerebral gray matter loss, principally targeting motor and sensory systems, preferentially manifests later in the disease course. Interpretation FRDA is defined by an evolving spatial profile of neuroanatomical changes beyond primary pathology in the cerebellum and spinal cord, in line with its progressive clinical course. The design, interpretation, and generalization of research studies and clinical trials must consider neuroanatomical staging and associated interindividual variability in brain measures. ANN NEUROL 2021;90:570–583
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Affiliation(s)
- Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sidhant Chopra
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Filippo Arrigoni
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Sylvia Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Louise A Corben
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.,Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Andreas Deistung
- University Clinic and Outpatient Clinic for Radiology, Department for Radiation Medicine, University Hospital Halle (Saale), Halle (Saale), Germany.,Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Delatycki
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi,", University of Bologna, Bologna, Italy
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Stefania Evangelisti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marcondes C França
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Laura L Gramegna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Pierre-Gilles Henry
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Carlos R Hernandez-Castillo
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.,CONACYT-Institute of Neuroethology, University of Veracruz, Xalapa, Mexico
| | - Diane Hutter
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - James M Joers
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Christophe Lenglet
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - David N Manners
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alberto R M Martinez
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Andrea Martinuzzi
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Center, Conegliano, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi,", University of Bologna, Bologna, Italy
| | - Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,", University of Florence, Florence, Italy.,Clinical Epidemiology Unit, ISPRO, Oncological Network, Prevention and Research Institute, Florence, Italy
| | | | - Chiara Pane
- NSRO Department, University of Naples Federico II, Naples, Italy
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Pramod K Pisharady
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Thiago J R Rezende
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sandro Romanzetti
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Francesco Saccà
- NSRO Department, University of Naples Federico II, Naples, Italy
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Stefania Tirelli
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Marinela Vavla
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Center, Conegliano, Italy
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
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49
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Aguirre C, Miranda M, Stefani A. Nikolai Gogol's account of sleep paralysis in the tale "The Portrait". Sleep Med 2021; 85:317-320. [PMID: 34438188 DOI: 10.1016/j.sleep.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Several classical writers had an impressive power of observation and often depicted medical conditions in their works long before medical literature did. Sleep paralysis is a common and frightening experience, in particular when occurring for the first time. Therefore, it is not surprising that it has been frequently described in the classical literature, eg by Dostoevsky, Kafka, Dickens, and Maupassant. In Nikolai Gogol's tale "The portrait" (1833) we could recognize an excellent description of a sleep paralysis, in which several components of this condition were depicted including motor paralysis, visual and auditory hallucinations, and autonomic manifestations. To the best of our knowledge, this account is the earliest description of a sleep paralysis in non-medical literature.
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Affiliation(s)
- Carolina Aguirre
- Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Miranda
- Department of Neurology, Clínica Las Condes, Santiago, Chile
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Austria.
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50
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Miglis MG, Adler CH, Antelmi E, Arnaldi D, Baldelli L, Boeve BF, Cesari M, Dall'Antonia I, Diederich NJ, Doppler K, Dušek P, Ferri R, Gagnon JF, Gan-Or Z, Hermann W, Högl B, Hu MT, Iranzo A, Janzen A, Kuzkina A, Lee JY, Leenders KL, Lewis SJG, Liguori C, Liu J, Lo C, Ehgoetz Martens KA, Nepozitek J, Plazzi G, Provini F, Puligheddu M, Rolinski M, Rusz J, Stefani A, Summers RLS, Yoo D, Zitser J, Oertel WH. Biomarkers of conversion to α-synucleinopathy in isolated rapid-eye-movement sleep behaviour disorder. Lancet Neurol 2021; 20:671-684. [PMID: 34302789 DOI: 10.1016/s1474-4422(21)00176-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/19/2022]
Abstract
Patients with isolated rapid-eye-movement sleep behaviour disorder (RBD) are commonly regarded as being in the early stages of a progressive neurodegenerative disease involving α-synuclein pathology, such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy. Abnormal α-synuclein deposition occurs early in the neurodegenerative process across the central and peripheral nervous systems and might precede the appearance of motor symptoms and cognitive decline by several decades. These findings provide the rationale to develop reliable biomarkers that can better predict conversion to clinically manifest α-synucleinopathies. In addition, biomarkers of disease progression will be essential to monitor treatment response once disease-modifying therapies become available, and biomarkers of disease subtype will be essential to enable prediction of which subtype of α-synucleinopathy patients with isolated RBD might develop.
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Affiliation(s)
- Mitchell G Miglis
- Department of Neurology and Neurological Sciences and Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA.
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Bradley F Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irene Dall'Antonia
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Nico J Diederich
- Department of Neuroscience, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | | | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal-Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Ziv Gan-Or
- The Neuro-Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, and Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE), Research Site Rostock, Rostock, Germany
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Annette Janzen
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany
| | | | - Jee-Young Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Klaus L Leenders
- Department of Nuclear Medicine and Biomedical Imaging, University Medical Center Groningen, Groningen, Netherlands
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Claudio Liguori
- Sleep Medicine Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Christine Lo
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kaylena A Ehgoetz Martens
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; UOC Clinica Neurologica Rete Metropolitana NEUROMET, Bellaria Hospital, Bologna, Italy
| | - Monica Puligheddu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Michal Rolinski
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jennifer Zitser
- Department of Neurology and Neurological Sciences, University of California, San Francisco, CA, USA; Department of Neurology, Tel Aviv Sourasky Medical Center, Affiliate of Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wolfgang H Oertel
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany; Institute for Neurogenomics, Helmholtz Center for Health and Environment, München-Neuherberg, Germany
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