Parkinsonism with excessive daytime sleepiness A narcolepsy-like disorder?

@article{citeulike:116414, abstract = {BACKGROUND : Parkinsonian patients with excessive daytime sleepiness (EDS), hallucinations, REM sleep behavior disorder (RBD), short mean sleep latencies, and sleep-onset REM periods (SOREMP) on multiple sleep latency tests (MSLT) have been reported. In these patients a narcolepsy-like pathophysiology of sleep-wake disturbances has been suggested. PATIENTS AND METHODS : We studied 14 consecutive patients with Parkinsonism and EDS. Standard studies included assessment of duration and severity of Parkinsonism (Hoehn \& Yahr score), Epworth sleepiness score (ESS), history of "REM-symptoms" (RBD/hallucinations/sleep paralysis/cataplexy-like episodes), polysomnography (PSG),MSLT, and measurement of cerebrospinal fluid (CSF) levels of hypocretin-1 (orexin A). RESULTS : There were 12 men and 2 women (mean age 69 years; range 54-82). The mean duration and the Hoehn \& Yahr score were 6.3 years and 2.2, respectively. Diagnoses included idiopathic Parkinson's disease (IPD, n=10), dementia with diffuse Lewy bodies (n=3), and multisystem atrophy (n=1). The ESS was >/=10 in all patients (mean 12; range 10-18). "REM-symptoms" were reported by all but two patients (hallucinations: n=9; RBD: n=9).None of the patients reported cataplexy-like symptoms or sleep paralysis. On PSG sleep apnea (apnea hypopnea index > 10/h, n=7), periodic limb movements during sleep (PLMS-index > 10/h, n=6), and features of RBD (n=5) were found. On MSLT mean sleep latency was < 5 minutes in 10 patients, and SOREMP were found in two patients. When compared with controls (n=20, mean 497 pg/ml; range 350-603), CSF hypocretin-1 levels were normal in 8 patients and low in 2 patients (221 and 307 pg/ml, respectively). CONCLUSION : These findings do not support the hypothesis of a "final common pathway" in the pathophysiology of narcolepsy and Parkinsonism with EDS. Sleep apnea and PLMS may play a so-far underestimated role in the pathogenesis of EDS in Parkinsonian patients.}, address = {Neurologische Poliklinik, Universit\"{a}tsspital Z\"{u}rich, Frauenklinikstrasse 26, 8091, Z\"{u}rich, Switzerland, claudio.bassetti@usz.ch.}, author = {Baumann, C. and Ferini-Strambi, L. and Waldvogel, D. and Werth, E. and Bassetti, C. L. }, citeulike-article-id = {116414}, issn = {0340-5354}, journal = {J Neurol}, month = {February}, number = {2}, pages = {139--145}, posted-at = {2008-04-28 21:31:16}, priority = {0}, title = {Parkinsonism with excessive daytime sleepiness A narcolepsy-like disorder?}, url = {http://dx.doi.org/10.1007/s00415-005-0614-5}, volume = {252}, year = {2005} }

TY - JOUR ID - citeulike:116414 L3 - citeulike-article-id:116414 TI - Parkinsonism with excessive daytime sleepiness A narcolepsy-like disorder? JF - J Neurol VL - 252 IS - 2 SP - 139 EP - 145 AD - Neurologische Poliklinik, Universitätsspital Zürich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland, claudio.bassetti@usz.ch. SN - 0340-5354 N2 - BACKGROUND : Parkinsonian patients with excessive daytime sleepiness (EDS), hallucinations, REM sleep behavior disorder (RBD), short mean sleep latencies, and sleep-onset REM periods (SOREMP) on multiple sleep latency tests (MSLT) have been reported. In these patients a narcolepsy-like pathophysiology of sleep-wake disturbances has been suggested. PATIENTS AND METHODS : We studied 14 consecutive patients with Parkinsonism and EDS. Standard studies included assessment of duration and severity of Parkinsonism (Hoehn & Yahr score), Epworth sleepiness score (ESS), history of "REM-symptoms" (RBD/hallucinations/sleep paralysis/cataplexy-like episodes), polysomnography (PSG),MSLT, and measurement of cerebrospinal fluid (CSF) levels of hypocretin-1 (orexin A). RESULTS : There were 12 men and 2 women (mean age 69 years; range 54-82). The mean duration and the Hoehn & Yahr score were 6.3 years and 2.2, respectively. Diagnoses included idiopathic Parkinson's disease (IPD, n=10), dementia with diffuse Lewy bodies (n=3), and multisystem atrophy (n=1). The ESS was >/=10 in all patients (mean 12; range 10-18). "REM-symptoms" were reported by all but two patients (hallucinations: n=9; RBD: n=9).None of the patients reported cataplexy-like symptoms or sleep paralysis. On PSG sleep apnea (apnea hypopnea index > 10/h, n=7), periodic limb movements during sleep (PLMS-index > 10/h, n=6), and features of RBD (n=5) were found. On MSLT mean sleep latency was < 5 minutes in 10 patients, and SOREMP were found in two patients. When compared with controls (n=20, mean 497 pg/ml; range 350-603), CSF hypocretin-1 levels were normal in 8 patients and low in 2 patients (221 and 307 pg/ml, respectively). CONCLUSION : These findings do not support the hypothesis of a "final common pathway" in the pathophysiology of narcolepsy and Parkinsonism with EDS. Sleep apnea and PLMS may play a so-far underestimated role in the pathogenesis of EDS in Parkinsonian patients. AU - Baumann, C AU - Ferini-Strambi, L AU - Waldvogel, D AU - Werth, E AU - Bassetti, CL PY - 2005/02// UR - http://dx.doi.org/10.1007/s00415-005-0614-5 ER -