Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder
Abstract
We report longitudinal data on a group of 29 male patients 50 years of age or older who were initially diagnosed as having idiopathic REM sleep behavior disorder (RBD) after extensive polysomnographic and neurologic evaluations.Thirty-eight percent (11/29) were eventually diagnosed as having a parkinsonian disorder (presumably Parkinson's disease) at a mean interval of 3.7 plus minus 1.4 (SD) years after the diagnosis of RBD, and at a mean interval of 12.7 plus minus 7.3 years after the onset of RBD. To date, only 7% (2/29) of patients have developed any other neurologic disorder. At the time of RBD diagnosis, data from the RBD group with eventual Parkinson's disease (n equals 11) and the current idiopathic RBD group (n equals 16) were indistinguishable, with two exceptions: the RBD-Parkinson's disease group had a significantly elevated hourly index of periodic limb movements of non-REM sleep and an elevated REM sleep percentage. RBD was fully or substantially controlled with nightly clonazepam treatment in 89% (24/27) of patients in both groups. Thus, RBD can be the heralding manifestation of Parkinson's disease in a substantial subgroup of older male RBD patients. However, a number of presumed Parkinson's disease patients may eventually be diagnosed with multiple system atrophy (straitonigral degeneration subtype). Our findings indicate the importance of serial neurologic evaluations after RBD is diagnosed and implicate the pedunculopontine nucleus as a likely site of pathology in combined RBD-Parkinson's disease, based on experimental and theoretical considerations rather than on autopsy data.
NEUROLOGY 1996;46: 388-393
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REFERENCES
1.
Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986;9:293-308.
2.
Schenck CH, Bundlie SR, Patterson AL, Mahowald MW. Rapid eye movement sleep behavior disorder: a treatable parasomnia affecting older adults. JAMA 1987;257:1786-1789.
3.
Schenck CH, Mahowald MW. A polysomnographic, neurologic, psychiatric and clinical outcome report on 70 consecutive cases with REM sleep behavior disorder (RBD): sustained clonazepam efficacy in 89.5% of 57 treated patients. Clev Clin J Med 1990;57(Suppl):10-24.
4.
Schenck CH, Mahowald MW. Motor dyscontrol in narcolepsy: rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder. Ann Neurol 1992;32:3-10.
5.
Schenck CH, Hurwitz TD, Mahowald MW. REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature. J Sleep Res 1993;2:224-231.
6.
Mahowald MW, Schenck CH. REM sleep behavior disorder. In: Kryger MH, Roth T, Dement WC, eds. Principles and practice of sleep medicine. 2nd ed. Philadelphia: WB Saunders, 1994:574-578.
7.
Jouvet M, Delorme F. Locus coeruleus et sommeil paradoxal. C R Soc Biol 1965;159:895-898.
8.
Hendricks JC, Morrison AR, Mann GL. Different behaviors during paradoxical sleep without atonia depend on pontine lesion site. Brain Res 1982;239:81-105.
9.
Schenck CH, Milner DM, Hurwitz TD, Bundlie SR, Mahowald MW. A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry 1989;146:1166-1173.
10.
Rechtschaffen A, Kales AA. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Bethesda, MD: National Institute of Neurological Diseases and Blindness, 1968.
11.
Richardson GS, Carskadon MA, Flagg W, et al. Excessive daytime sleepiness in man: multiple sleep latency measurement in narcoleptic and control subjects. Electroencephalogr Clin Neurophysiol 1978;45:621-627.
12.
Cox S, Risse G, Hawkins J, Schenck C, Mahowald M. Neuro-psychological data in 34 patients with REM sleep behavior disorder (RBD) [abstract]. Sleep Res 1990;19:206.
13.
Kirkpatrick JB, Hayman LA. White-matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis. Radiology 1987;162:509-511.
14.
Thorpy MJ. Diagnostic Classification Steering Committee. International classification of sleep disorders: diagnostic and coding manual. Rochester, MN: American Sleep Disorders Association, 1990.
15.
Calne DB, Snow BJ, Lee C. Criteria for diagnosing Parkinson's disease. Ann Neurol 1992;32(Suppl):125-127.
16.
Schenck CH, Hopwood J, Duncan E, Mahowald MW. Preservation and loss of REM-atonia in human idiopathic REM sleep behavior disorder (RBD): quantitative polysomnographic (PSG) analyses in 17 patients [abstract]. Sleep Res 1992;21:16.
17.
Koller WC. How accurately can Parkinson's disease be diagnosed? Neurology 1992;42(suppl 1):6-16.
18.
Wright BA, Rosen JR, Buysse DJ, Reynolds CF, Zubenko GS. Shy-Drager syndrome presenting as a REM behavioral disorder. J Geriatr Psychiatry Neurol 1990;3:110-113.
19.
Tison F, Wenning GK, Quinn NP, Smith SJM. REM sleep behaviour disorder as the presenting symptom of multiple system atrophy [letter]. J Neurol Neurosurg Psychiatry 1995;58:379-380.
20.
Uchiyama M, Isse K, Tanaka K, et al. Incidental Lewy body disease in a patient with REM sleep behavior disorder. Neurology 1995;45:709-712.
21.
Lapierre O, Montplaisir J. Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 1992;42:1371-1374.
22.
Peiris JB, Boralessa H, Lionel NDW. Clonazepam in the treatment of choreiform activity. Med J Aust 1976;1:225-227.
23.
Loeb C, Priano A. Preliminary evaluation of the effects of clonazepam on parkinsonian tremor. Eur Neurol 1977;15:143-145.
24.
Hipola D, Mateo D, Gimenez-Roldan S. Meige's syndrome: acute and chronic responses to clonazepam and anticholinergics. Eur Neurol 1984;23:474-478.
25.
Biary N, Pimental PA, Langenberg PW. A double-blind trial of clonazepam in the treatment of parkinsonian dysarthria. Neurology 1988;38:255-258.
26.
Horiguchi J, Inami Y. Effect of clonazepam on neuroleptic-induced oculogyric crisis. Acta Psychiatr Scand 1989;80:521-523.
27.
Povlsen UJ, Pakkenberg H. Effect of intravenous injection of biperiden and clonazepam in dystonia. Movement Dis 1990;5:27-31.
28.
Horiguchi J, Nishimatsu O. Usefulness of antiparkinsonian drugs during neuroleptic treatment and the effect of clonazepam on akathisia and parkinsonism occurred after antiparkinsonian drug withdrawal: a double-blind study. Jpn J Psychiatr Neurol 1992;46:733-739.
29.
Weiner WJ, Goetz C, Nausieda PA, Klawans HL. Clonazepam and dopamine-related stereotyped behavior. Life Sci 1977;21:901-906.
30.
Nakamura K, Shimokawa Y, Oikawa Y, Nakamura K. Influence of clonazepam, an anticonvulsant benzodiazepine drug, on the rat brain monoamine containing neurons, especially on dopaminergic neurons. Folia Pharmacol (Japon) 1978;74:251-265.
31.
Bartholini G, Scatton B, Zivkovic B, Lloyd KG. GABA receptor agonists and extrapyramidal motor function: therapeutic implications for Parkinson's disease. Adv Neurol 1986;45:79-83.
32.
Keller HH, Schaffner R, Haefely W. Interaction of benzodiazepines with neuroleptics at central dopamine neurons. Naunyn Schmiedebergs Arch Pharamcol 1976;294:1-7.
33.
Wood PL, Etienne P, Lal S, Nair NPV. Benzodiazepines and GABAergic regulation of nigrostriatal neurons: lack of tolerance. Prog Neuropsychopharmacol Biol Psychiatry 1984;8:779-783.
34.
Schenck CH, Halfaker BA, Mahowald MW. Sustained benefit and low risk of major adverse effects during long-term nightly benzodiazepine and/or opiate treatment of injurious parasomnias, restless legs/periodic limb movement disorder and insomnia in 121 adult patients [abstract]. Sleep Res 1994;23:81.
35.
Poceta JS, Erman MK, Mitler MM. Sleep disorders in patients with Parkinson's disease [abstract]. Sleep Res 1991;20A:441.
36.
Silber MH, Ahlskog JE. REM sleep behavior disorder in parkinsonian syndromes [abstract]. Sleep Res 1992;21:313.
37.
Silber MH, Dexter DD, Ahlskog JE, Hauri PJ, Shepard JW. Abnormal REM sleep motor activity in untreated Parkinson's disease [abstract]. Sleep Res 1993;22:274.
38.
Comella CL, Tanner CM, Ristanovic RK. Polysomnographic sleep measures in Parkinson's disease patients with treatment-induced hallucinations. Ann Neurol 1993;34:710-714.
39.
Sakai K, Sastre J-P, Danamori N, Jouvet M. State-specific neurons in the ponto-medullary reticular formation with special reference to the postural atonia during paradoxical sleep in the cat. In: Pompeiano O, Marsan CA, eds. Brain mechanisms of perceptual awareness and purposeful behavior. New York: Raven Press, 1981:405-429.
40.
Lai YY, Siegel JM. Medullary regions mediating atonia. J Neurosci 1988;8:4790-4796.
41.
Lai YY, Siegel JM. Corticotropin-releasing factor mediated muscle atonia in pons and medulla. Brain Res 1992;575:63-68.
42.
Garcia-Rill E. The pedunculopontine nucleus. Prog Neurobiol 1991;36:363-389.
43.
Jellinger KA. Pathology of Parkinson's disease: changes other than the nigrostriatal pathway. Mol Chem Neuropathol 1991;14:153-197.
44.
Lai YY, Siegel JM. Muscle tone suppression and stepping produced by stimulation of midbrain and rostral pontine reticular formation. J Neurosci 1990;10:2727-2734.
45.
Shouse MN, Siegel JM. Pontine regulation of REM sleep components in cats: integrity of the pedunculopontine tegmentum (PPT) is important for phasic events but unnecessary for atonia during REM sleep. Brain Res 1992;571:50-63.
46.
Datta S, Dossi RC, Pare D, Oakson G, Steriade M. Substantia nigra reticulata neurons during sleep-waking states: relation with ponto-geniculo-occipital waves. Brain Res 1991;566:344-347.
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Copyright 1996 by Advanstar Communications Inc.
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Published online: February 1, 1996
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