Skip to main content

Advertisement

SpringerLink
Log in

Transcranial midbrain sonography in narcoleptic subjects with and without concomitant REM sleep behaviour disorder

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Substantia nigra (SN) hyperechogenicity—a sonographic vulnerability marker for Parkinson’s disease (PD)—has been recently described in patients with idiopathic REM sleep behaviour disorder (RBD). It is not known whether subjects with narcolepsy (who frequently have associated RBD) also show SN hyperechogenicity. The aim of this study was to (1) evaluate SN echogenicity in narcolepsy and (2) determine whether transcranial sonography (TCS) differs in narcoleptic subjects with and without RBD. A total of 16 patients with narcolepsy–cataplexy (7 had a concomitant, video-polysomnographically based diagnosis of RBD) were examined with TCS by two investigators blinded to the clinical data. The size of the SN echogenic area in both subgroups was within the range previously described for healthy subjects. The brainstem raphe, however, was reduced in five of seven narcoleptic subjects with RBD, whereas only two of nine narcoleptic subjects without RBD exhibited this TCS finding. We conclude that evaluation of SN echogenicity does not discriminate between both subgroups. The absence of SN hyperechogenicity in narcoleptic patients with RBD supports the hypothesis that SN hyperechogenicity in patients with presumed idiopathic RBD is an additional risk marker for subsequent evolvement of PD rather than an RBD-immanent finding. Reduced echogenicity of the brainstem raphe might indicate an involvement of the serotonergic system in narcoleptic subjects with RBD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arnulf I, Konofal E, Merino-Andreu M, Houeto JL, Mesnage V, Welter ML, Lacomblez L, Golmard JL, Derenne JP, Agid Y (2002) Parkinson’s disease and sleepiness: an integral part of PD. Neurology 58:1019–1024

    PubMed  CAS  Google Scholar 

  2. Behnke S, Berg D, Becker G (2003) Does ultrasound disclose a vulnerability factor for Parkinson’s disease? J Neurol 250(Suppl 1):24–27

    Google Scholar 

  3. Körner Y, Meindorfner C, Möller JC, Stiasny-Kolster K, Haja D, Cassel W, Oertel WH, Krüger HP (2004) Predictors of sudden onset of sleep in Parkinson’s disease. Mov Disord 19:1298–1305

    Article  PubMed  Google Scholar 

  4. Maeda T, Nagata K, Kondo H, Kanbayashi T (2006) Parkinson’s disease comorbid with narcolepsy presenting low CSF hypocretin/orexin level. Sleep Med 7:662

    Article  PubMed  Google Scholar 

  5. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW (1986) Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 9:293–308

    PubMed  CAS  Google Scholar 

  6. Stiasny-Kolster K, Clever SC, Möller JC, Oertel WH, Mayer G (2007) Olfactory dysfunction in patients with narcolepsy with and without REM sleep behaviour disorder. Brain 130:442–449

    Article  PubMed  CAS  Google Scholar 

  7. Thannickal TC, Lai YY, Siegel JM (2007) Hypocretin (orexin) cell loss in Parkinson’s disease. Brain 130:1586–1595

    Article  PubMed  Google Scholar 

  8. Unger MM, Möller JC, Stiasny-Kolster K, Mankel K, Berg D, Walter U, Hoeffken H, Mayer G, Oertel WH (2008) Assessment of idiopathic rapid-eye-movement sleep behaviour disorder by transcranial sonography, olfactory function test and FP-CIT-SPECT—the diverse pattern in this subgroup of subjects at risk for parkinsonian syndromes. Mov Disord 23:596–599

    Article  PubMed  Google Scholar 

  9. Walter U, Dressler D, Wolters A, Wittstock M, Benecke R (2006) Overactive bladder in Parkinson’s disease: alteration of brainstem raphe detected by transcranial sonography. Eur J Neurol 13:1291–1297

    Article  PubMed  CAS  Google Scholar 

  10. Walter U, Behnke S, Eyding J, Niehaus L, Postert T, Seidel G, Berg D (2007) Transcranial brain parenchyma sonography in movement disorders: state of the art. Ultrasound Med Biol 33:15–25

    Article  PubMed  Google Scholar 

  11. Walter U, Dressler D, Wolters A, Wittstock M, Benecke R (2007) Transcranial brain sonography findings in clinical subgroups of idiopathic Parkinson’s disease. Mov Disord 22:48–54

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants from the BMBF (funding code: 01GI0401) and the Willy und Monika Pitzer Stiftung.

Conflict of interest statement

The authors declare that there is no conflict of interest regarding this work.

Author information

Authors and Affiliations

  1. Department of Neurology, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany

    Marcus M. Unger, Jens C. Möller, Tim Ohletz, Karin Stiasny-Kolster & Wolfgang H. Oertel

  2. Hephata-Clinic for Neurology, Schimmelpfengstraße 6, 34613, Schwalmstadt-Treysa, Germany

    Geert Mayer

Authors
  1. Marcus M. Unger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens C. Möller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tim Ohletz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karin Stiasny-Kolster
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolfgang H. Oertel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Geert Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcus M. Unger.

Additional information

W.H. Oertel and G. Mayer contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Unger, M.M., Möller, J.C., Ohletz, T. et al. Transcranial midbrain sonography in narcoleptic subjects with and without concomitant REM sleep behaviour disorder. J Neurol 256, 874–877 (2009). https://doi.org/10.1007/s00415-009-5032-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-009-5032-7

Keywords

Search

Navigation