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Parkinsonism with excessive daytime sleepiness

A narcolepsy-like disorder?

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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.

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Authors and Affiliations

  1. Neurologische Poliklinik, Universitätsspital Zürich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland

    Christian Baumann, Daniel Waldvogel, Esther Werth &  Claudio Lino Bassetti

  2. Sleep Disorders Center, Università Vita-Salute San Raffaele, Milano, Italy

    Luigi Ferini-Strambi

Authors
  1. Christian Baumann
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  2. Luigi Ferini-Strambi
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  3. Daniel Waldvogel
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  4. Esther Werth
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  5. Claudio Lino Bassetti
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Correspondence to Claudio Lino Bassetti.

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Baumann, C., Ferini-Strambi, L., Waldvogel, D. et al. Parkinsonism with excessive daytime sleepiness. J Neurol 252, 139–145 (2005). https://doi.org/10.1007/s00415-005-0614-5

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  • DOI: https://doi.org/10.1007/s00415-005-0614-5

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