Five-year follow-up of substantia nigra echogenicity in idiopathic REM sleep behavior disorder

2014 ◽  
Vol 29 (14) ◽  
pp. 1774-1780 ◽  
Author(s):  
Alex Iranzo ◽  
Heike Stockner ◽  
Mónica Serradell ◽  
Klaus Seppi ◽  
Francesc Valldeoriola ◽  
...  
Keyword(s):  
Substantia Nigra ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Sleep Behavior ◽  
Substantia Nigra Echogenicity

Brainstem raphe and substantia nigra echogenicity in idiopathic REM sleep behavior disorder with comorbid depression

2015 ◽  
Vol 262 (7) ◽  
pp. 1665-1672 ◽  
Author(s):  
Dolores Vilas ◽  
Alex Iranzo ◽  
Claustre Pont-Sunyer ◽  
Mónica Serradell ◽  
Carles Gaig ◽  
...  
Keyword(s):  
Substantia Nigra ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Comorbid Depression ◽  
Sleep Behavior ◽  
Brainstem Raphe ◽  
Substantia Nigra Echogenicity

Comparative study of the substantia nigra echogenicity and 123I-Ioflupane spect in patients with REM sleep behavior disorder

2017 ◽  
Vol 40 ◽  
pp. e212
Author(s):  
J. Mašková ◽  
D. Školoudík ◽  
P. Dušek ◽  
K. Šonka ◽  
V. Ibarburu Lorenzo Y. Losada ◽  
...  
Keyword(s):  
Substantia Nigra ◽  
Comparative Study ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Sleep Behavior ◽  
Substantia Nigra Echogenicity

REM sleep behavior disorder

2017 ◽  
Author(s):  
Ronald B. Postuma
Keyword(s):  
Rem Sleep ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Clinical History ◽  
Final Diagnosis ◽  
Acting Out ◽  
Sleep Behavior ◽  
Rem Atonia

A diagnosis of REM sleep behavior disorder (RBD), a disorder characterized by “acting out” of dreams during REM sleep, has critical implications for a patient’s future. Aside from being a treatable parasomnia, usually managed with melatonin or clonazepam, RBD is the most powerful risk factor for Parkinson disease and dementia with Lewy bodies yet discovered. Over 70% of patients with idiopathic RBD will develop a neurodegenerative synucleinopathy. Moreover, the disease course is more severe in patients with RBD than those without. Numerous screens have been developed to aid detection, and clinical history can help distinguish RBD from NREM parasomnia. However, final diagnosis relies on polysomnographic documentation of REM atonia loss. Given the profound implications of idiopathic RBD, patients need careful counseling and the offer of neurological follow-up to detect and treat prodromal disease symptoms. Recognition of RBD is also a means to discover and test protective therapies against neurodegenerative disease.

Relevance of substantia nigra hyperechogenicity and reduced odor identification in idiopathic REM sleep behavior disorder

2010 ◽  
Vol 11 (4) ◽  
pp. 361-365 ◽  
Author(s):  
Masaoki Iwanami ◽  
Tomoyuki Miyamoto ◽  
Masayuki Miyamoto ◽  
Koichi Hirata ◽  
Etsuo Takada
Keyword(s):  
Substantia Nigra ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Odor Identification ◽  
Sleep Behavior ◽  
Substantia Nigra Hyperechogenicity

scholarly journals Loss of Substantia Nigra Hyperintensity at 3.0-T MR Imaging in Idiopathic REM Sleep Behavior Disorder: Comparison with 123I-FP-CIT SPECT

Radiology ◽  
2018 ◽  
Vol 287 (1) ◽  
pp. 285-293 ◽  
Author(s):  
Yun Jung Bae ◽  
Jong-Min Kim ◽  
Kyeong Joon Kim ◽  
Eunhee Kim ◽  
Hyun Soo Park ◽  
...  
Keyword(s):  
Substantia Nigra ◽  
Mr Imaging ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Sleep Behavior ◽  
3.0 T

scholarly journals Conversion to Parkinsonism and Dementia in REM-Sleep Behavior Disorder Using the Chronobiotic Melatonin

2020 ◽  
Author(s):  
Dieter Kunz ◽  
Sophia Stotz ◽  
Frederik Bes
Keyword(s):  
Rem Sleep ◽  
Symptom Severity ◽  
Beta Blockers ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Clock Time ◽  
Melatonin Treatment ◽  
Sleep Behavior ◽  
Disease Modifying

ABSTRACTBackgroundIsolated REM sleep behavior disorder (iRBD), a reliable prodromal stage marker of α-synucleinopathies like Parkinson’s disease or Lewy body dementia, offers an early window for disease-modifying intervention. Current treatments of iRBD, including the two level B therapies with clonazepam and melatonin, are considered symptomatic. However, numbers of reported patients treated with melatonin are low and whether melatonin has disease-modifying potential is unclear.MethodsThis single-center, prospective cohort study included 206 consecutive patients diagnosed with iRBD until January 2020. Thirty-nine patients had applied mixed treatments on the advice of the referring physician, 167 had administered melatonin according to our chronobiotic protocol (low dose, ≥ 6 months, always-at-the-same-clock-time, between 10 and 11 pm - corrected for chronotype), which differs from existing melatonin prescriptions. Clinical examination to determine phenoconversion was performed from October 2018 to August 2020. To evaluate generalizability, we compared factors such as neuropsychological and neuromotor performance, olfactory ability, neurovegetative behavior, and dopamine transporter density in our patients with those reported for other cohorts. Primary outcome was phenoconversion to clinical synucleinopathy, assessed using Kaplan-Meier analysis. Secondary outcomes were changes in cognitive and motor performance, and in RBD-symptom severity, analyzed using mixed models.ResultsRBD characteristics were comparable to those in other published cohorts, including frequency of phenoconversion in our patients with mixed treatments (10/39; follow-up 3.1±2.1 years). In contrast, long-term melatonin-treated patients rarely converted (4/167; follow-up 4.2±3.1 years; hazard-ratio 0.07, 95% CI, 0.02-0.22, p<0.001). Neuromotor and neuropsychological performance did not decline, improved in some domains. Symptom severity gradually improved over the first 4 weeks of treatment (Clinical Global Impression Severity: 5.7 vs. 3.0) and remained stable over years, also in those patients who had stopped melatonin intake after 6 months. The initial response was slower in patients with melatonin suppressing (beta blockers) or REM sleep spoiling co-medication (antidepressants) and failed with inadequate timing of melatonin intake.ConclusionClock-timed melatonin treatment in patients with iRBD appears to be associated with a marked reduction in the development of parkinsonism and dementia as well as with an improvement in neuromotor, cognitive, and specific RBD symptoms. Findings suggest that melatonin treatment may have disease-modifying effects in synucleinopathies. The fact that melatonin is available anywhere at low cost provides the perspective of immediate clinical application in patients at risk for clinical synucleinopathy. On the other hand, clock-time dependency challenges existing prescription guidelines for melatonin. Melatonin should be acknowledged as the darkness signal to circadian clock-work rather than a hypnotic.

Left-hemispheric predominance of nigrostriatal deficit in isolated REM sleep behavior disorder

Neurology ◽  
2020 ◽  
Vol 94 (15) ◽  
pp. e1605-e1613 ◽  
Author(s):  
Alex Iranzo ◽  
Ambra Stefani ◽  
Aida Niñerola-Baizan ◽  
Heike Stokner ◽  
Monica Serradell ◽  
...  
Keyword(s):  
Substantia Nigra ◽  
Caudate Nucleus ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Transcranial Sonography ◽  
Sleep Behavior ◽  
Left Caudate ◽  
Dat Spect ◽  
The Right

ObjectiveUnilateral onset of parkinsonism due to nigrostriatal damage of the contralateral hemisphere is frequent in Parkinson disease (PD). There is evidence for a left-hemispheric bias of motor asymmetry in right-handed patients with PD indicating a hemispheric dominance. Isolated REM sleep behavior disorder (IRBD) constitutes the prodromal stage of PD and other synucleinopathies. To test the hypothesis that right-handed patients with IRBD exhibit left-hemispheric predominance of subclinical nigrostriatal dysfunction, we evaluated this aspect using neuroimaging instruments.MethodsIn 167 right-handed patients with IRBD without parkinsonism, we evaluated in each hemisphere the integrity of the striatal dopaminergic terminals by dopamine transporter (DAT)-SPECT and the substantia nigra echogenicity by transcranial sonography.ResultsDAT-SPECT showed lower specific binding ratio (SBR) in the left striatum and left caudate nucleus than in the right striatum and right caudate nucleus. The percentage of patients with lower SBR was greater in the left striatum and left caudate nucleus than in the right striatum and right caudate nucleus. In those who developed a synucleinopathy in <5 years from DAT-SPECT, there was a lower SBR in the left putamen and left caudate nucleus than in the right putamen and right caudate nucleus. Substantia nigra echogenic size was greater in the left than in the right side in patients with hyperechogenicity and among individuals who phenoconverted in <5 years from transcranial sonography.ConclusionRight-handed patients with IRBD exhibit left-hemispheric predominance of subclinical nigrostriatal dysfunction. In premotor PD, the neurodegenerative process begins asymmetrically, initially impairing the nigrostriatal system of the dominant hemisphere.

scholarly journals 0787 Autonomic Dysfunction and Phenoconversion in Idiopathic/Isolated REM Sleep Behavior Disorder

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A300-A300
Author(s):  
S McCarter ◽  
T Gehrking ◽  
E St. Louis ◽  
M Suarez ◽  
B Boeve ◽  
...  
Keyword(s):  
Autonomic Dysfunction ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Common Finding ◽  
Chi Square ◽  
Sleep Behavior ◽  
Autonomic Testing ◽  
Function Testing

Abstract Introduction REM-sleep behavior disorder (RBD) is a common finding among patients with synucleinopathies. We aimed to determine the degree of autonomic dysfunction in patients presenting with idiopathic RBD (iRBD), and the predictive value of autonomic dysfunction for phenoconversion to a defined neurodegenerative disease. Methods We searched our electronic medical record for patients diagnosed with iRBD who also underwent standardized autonomic function testing within 6 months of iRBD diagnosis, and who had clinical follow-up of at least 3 years following iRBD diagnosis. Patients who received a diagnosis of phenoconversion within 3 months of autonomic testing were excluded. The composite autonomic severity score (CASS) was derived and compared between phenoconverters and non-converters using chi-square and Wilcoxon rank-sum tests. Results We identified 18 patients who fulfilled in- and exclusion criteria. Average age at autonomic testing was 67 ± 6.6 years. Twelve (67%) patients phenoconverted during the follow-up period; 6 developed PD, the other 6 DLB. Fifteen (83%) patients had at least mild autonomic dysfunction. There were no significant differences between overall converters and non-converters in total CASS or CASS subscores. However, iRBD patients who developed DLB had significantly higher total and cardiovagal CASS scores compared with those who developed PD (p &lt;0.05), and a trend for higher adrenergic CASS scores compared to those who developed PD and those who did not phenoconvert (p=0.08 for each). Conclusion Autonomic dysfunction was seen in 83% of iRBD patients, and more severe baseline cardiovagal and adrenergic autonomic dysfunction in iRBD was associated with phenoconversion to DLB but not PD. Prospective studies are needed to confirm the value of autonomic testing for predicting phenoconversion and disease phenotype in iRBD. Support  

Sign in / Sign up

Export Citation Format

Share Document