CNS Drugs

, Volume 25, Issue 3, pp 203–212

Excessive Daytime Sleepiness in Patients with Parkinson’s Disease

  • Bettina Knie
  • M. Tanya Mitra
  • Kartik Logishetty
  • K. Ray Chaudhuri
Review Article


Excessive daytime sleepiness (EDS) is described as inappropriate and undesirable sleepiness during waking hours and is a common non-motor symptom in Parkinson’s disease, affecting up to 50% of patients. EDS has a large impact on the quality of life of Parkinson’s disease patients as well as of their caregivers, in some cases even more than the motor symptoms of the disease. Drug-induced EDS is a particular problem as many dopamine agonists used for the treatment of Parkinson’s disease have EDS as an adverse effect. Dopaminergic treatment may also render a subset of Parkinson’s disease patients at risk for sudden-onset sleep attacks that occur without warning and can be particularly hazardous if the patient is driving. This demonstrates the need for early recognition and management not only to increase health-related quality of life but also to ensure patient safety. There are many assessment tools for EDS, including the Epworth Sleepiness Scale (ESS) and the Multiple Sleep Latency Test (MSLT), although only the Parkinson’s Disease Sleep Scale (PDSS) and the SCales for Outcomes in PArkinson’s Disease-Sleep (SCOPA-S) are specifically validated for Parkinson’s disease. Polysomnography can be used when necessary.

Management comprises non-pharmacological and pharmacological approaches. Non-pharmacological approaches can be the mainstay of treatment for mild to moderate EDS. Advice on good sleep hygiene is instrumental, as pharmacological approaches have yet to provide consistent and reliable results without significant adverse effects. The efficacy of pharmacological treatment of EDS in Parkinson’s disease using wakefulness-promoting drugs such as modafinil remains controversial. Further areas of research are now also focusing on adenosine A2A receptor antagonists, sodium oxybate and caffeine to promote wakefulness. A definitive treatment for the highly prevalent drug-induced EDS has not yet been found.


  1. 1.
    Shulman LM, Taback RL, Rabinstein AA, et al. Non-recognition of depression and other non-motor symptoms in Parkinson’s disease. Parkinsonism Relat Disord 2002 Jan; 8(3): 193–7PubMedCrossRefGoogle Scholar
  2. 2.
    Aarsland D, Larsen JP, Tandberg E, et al. Predictors of nursing home placement in Parkinson’s disease: a population-based, prospective study. J Am Geriatr Soc 2000 Aug; 48(8): 938–42PubMedGoogle Scholar
  3. 3.
    Karlsen KH, Larsen JP, Tandberg E, et al. Influence of clinical and demographic variables on quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999 Apr; 66(4): 431–5PubMedCrossRefGoogle Scholar
  4. 4.
    Verbaan D, van Rooden SM, Visser M, et al. Nighttime sleep problems and daytime sleepiness in Parkinson’s disease. Mov Disord 2008 Jan; 23(1): 35–41PubMedCrossRefGoogle Scholar
  5. 5.
    Adler CH, Thorpy MJ. Sleep issues in Parkinson’s disease. Neurology 2005 Jun 28; 64(12 Suppl. 3): S12–20PubMedCrossRefGoogle Scholar
  6. 6.
    Abbott RD, Ross GW, White LR, et al. Excessive daytime sleepiness and subsequent development of Parkinson disease. Neurology 2005 Nov 8; 65(9): 1442–6PubMedCrossRefGoogle Scholar
  7. 7.
    Tandberg E, Larsen JP, Karlsen K. Excessive daytime sleepiness and sleep benefit in Parkinson’s disease: a community-based study. Mov Disord 1999 Nov; 14(6): 922–7PubMedCrossRefGoogle Scholar
  8. 8.
    O’Suilleabhain PE, Dewey Jr RB. Contributions of dopaminergic drugs and disease severity to daytime sleepiness in Parkinson disease. Arch Neurol 2002 Jun; 59(6): 986–9PubMedCrossRefGoogle Scholar
  9. 9.
    Diederich NJ, Vaillant M, Mancuso G, et al. Progressive sleep ‘destructuring’ in Parkinson’s disease: a polysomnographic study in 46 patients. Sleep Med 2005 Jul; 6(4): 313–8PubMedCrossRefGoogle Scholar
  10. 10.
    Thannickal TC, Lai YY, Siegel JM. Hypocretin (orexin) cell loss in Parkinson’s disease. Brain 2007 Jun; 130 (Pt 6): 1586–95PubMedCrossRefGoogle Scholar
  11. 11.
    Ondo WG, Dat Vuong K, Khan H, et al. Daytime sleepiness and other sleep disorders in Parkinson’s disease. Neurology 2001 Oct 23; 57(8): 1392–6PubMedCrossRefGoogle Scholar
  12. 12.
    Tan EK, Lum SY, Fook-Chong SM, et al. Evaluation of somnolence in Parkinson’s disease: comparison with age-and sex-matched controls. Neurology 2002 Feb 12; 58(3): 465–8PubMedCrossRefGoogle Scholar
  13. 13.
    Kumar S, Bhatia M, Behari M. Excessive daytime sleepiness in Parkinson’s disease as assessed by Epworth Sleepiness Scale (ESS). Sleep Med 2003 Jul; 4(4): 339–42PubMedCrossRefGoogle Scholar
  14. 14.
    Pal S, Bhattacharya KF, Agapito C, et al. A study of excessive daytime sleepiness and its clinical significance in three groups of Parkinson’s disease patients taking pramipexole, cabergoline and levodopa mono and combination therapy. J Neural Transm 2001; 108(1): 71–7PubMedCrossRefGoogle Scholar
  15. 15.
    Arnulf I. Excessive daytime sleepiness in parkinsonism. Sleep Med Rev 2005 Jun; 9(3): 185–200PubMedCrossRefGoogle Scholar
  16. 16.
    Gjerstad MD, Alves G, Wentzel-Larsen T, et al. Excessive daytime sleepiness in Parkinson disease: is it the drugs or the disease? Neurology 2006 Sep 12; 67(5): 853–8PubMedCrossRefGoogle Scholar
  17. 17.
    Rye DB, Bliwise DL, Dihenia B, et al. FAST TRACK: daytime sleepiness in Parkinson’s disease. J Sleep Res 2000 Mar; 9(1): 63–9PubMedCrossRefGoogle Scholar
  18. 18.
    Brodsky MA, Godbold J, Roth T, et al. Sleepiness in Parkinson’s disease: a controlled study. Mov Disord 2003 Jun; 18(6): 668–72PubMedCrossRefGoogle Scholar
  19. 19.
    Arnulf I, Konofal E, Merino-Andreu M, et al. Parkinson’s disease and sleepiness: an integral part of PD. Neurology 2002 Apr 9; 58(7): 1019–24PubMedCrossRefGoogle Scholar
  20. 20.
    Kaynak D, Kiziltan G, Kaynak H, et al. Sleep and sleepiness in patients with Parkinson’s disease before and after dopaminergic treatment. Eur J Neurol 2005 Mar; 12(3): 199–207PubMedCrossRefGoogle Scholar
  21. 21.
    Fabbrini G, Barbanti P, Aurilia C, et al. Excessive daytime sleepiness in de novo and treated Parkinson’s disease. Mov Disord 2002 Sep; 17(5): 1026–30PubMedCrossRefGoogle Scholar
  22. 22.
    Stevens S, Cormella CL, Stepanski EJ. Daytime sleepiness and alertness in patients with Parkinson disease. Sleep 2004 Aug 1; 27(5): 967–72PubMedGoogle Scholar
  23. 23.
    Tracik F, Ebersbach G. Sudden daytime sleep onset in Parkinson’s disease: polysomnographic recordings. Mov Disord 2001 May; 16(3): 500–6PubMedCrossRefGoogle Scholar
  24. 24.
    Ulivelli M, Rossi S, Lombardi C, et al. Polysomnographic characterization of pergolide-induced sleep attacks in idiopathic PD. Neurology 2002 Feb 12; 58(3): 462–5PubMedCrossRefGoogle Scholar
  25. 25.
    Boddy F, Rowan EN, Lett D, et al. Subjectively reported sleep quality and excessive daytime somnolence in Parkinson’s disease with and without dementia, dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry 2007 Jun; 22(6): 529–35PubMedCrossRefGoogle Scholar
  26. 26.
    Wegelin J, McNamara P, Durso R, et al. Correlates of excessive daytime sleepiness in Parkinson’s disease. Parkinsonism Relat Disord 2005 Nov; 11(7): 441–8PubMedCrossRefGoogle Scholar
  27. 27.
    Poryazova R, Benninger D, Waldvogel D, et al. Excessive daytime sleepiness in Parkinson’s disease: characteristics and determinants. Eur Neurol 2010; 63(3): 129–35PubMedCrossRefGoogle Scholar
  28. 28.
    Saper CB, Chou TC, Scammell TE. The sleep switch: hypothalamic control of sleep and wakefulness. Trends Neurosci 2001 Dec; 24(12): 726–31PubMedCrossRefGoogle Scholar
  29. 29.
    Rye DB, Jankovic J. Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 2002 Feb 12; 58(3): 341–6PubMedCrossRefGoogle Scholar
  30. 30.
    Fronczek R, Overeem S, Lee SY, et al. Hypocretin (orexin) loss in Parkinson’s disease. Brain 2007 Jun; 130 (Pt 6): 1577–85PubMedCrossRefGoogle Scholar
  31. 31.
    Drouot X, Moutereau S, Nguyen JP, et al. Low levels of ventricular CSF orexin/hypocretin in advanced PD. Neurology 2003 Aug 26; 61(4): 540–3PubMedCrossRefGoogle Scholar
  32. 32.
    Baumann C, Ferini-Strambi L, Waldvogel D, et al. Parkinsonism with excessive daytime sleepiness: a narcolepsy-like disorder? J Neurol 2005 Feb; 252(2): 139–45PubMedCrossRefGoogle Scholar
  33. 33.
    Overeem S, Scammell TE, Lammers GJ. Hypocretin/orexin and sleep: implications for the pathophysiology and diagnosis of narcolepsy. Curr Opin Neurol 2002 Dec; 15(6): 739–45PubMedCrossRefGoogle Scholar
  34. 34.
    Compta Y, Santamaria J, Ratti L, et al. Cerebrospinal hypocretin, daytime sleepiness and sleep architecture in Parkinson’s disease dementia. Brain 2009 Dec; 132 (Pt 12): 3308–17PubMedCrossRefGoogle Scholar
  35. 35.
    Rissling I, Geller F, Bandmann O, et al. Dopamine receptor gene polymorphisms in Parkinson’s disease patients reporting ‘sleep attacks’. Mov Disord 2004 Nov; 19(11): 1279–84PubMedCrossRefGoogle Scholar
  36. 36.
    Rissling I, Korner Y, Geller F, et al. Preprohypocretin polymorphisms in Parkinson disease patients reporting ‘sleep attacks’. Sleep 2005 Jul 1; 28(7): 871–5PubMedGoogle Scholar
  37. 37.
    Chaudhuri KR, Healy DG, Schapira AH. Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 2006 Mar; 5(3): 235–45PubMedCrossRefGoogle Scholar
  38. 38.
    Forsaa EB, Larsen JP, Wentzel-Larsen T, et al. Predictors and course of health-related quality of life in Parkinson’s disease. Mov Disord 2008 Jul 30; 23(10): 1420–7PubMedCrossRefGoogle Scholar
  39. 39.
    Qin Z, Zhang L, Sun F, et al. Health related quality of life in early Parkinson’s disease: impact of motor and non-motor symptoms, results from Chinese levodopa exposed cohort. Parkinsonism Relat Disord 2009 Dec; 15(10): 767–71PubMedCrossRefGoogle Scholar
  40. 40.
    Chaudhuri KR. Nocturnal symptom complex in PD and its management. Neurology 2003 Sep 23; 61(6 Suppl. 3): S17–23PubMedCrossRefGoogle Scholar
  41. 41.
    Razmy A, Lang AE, Shapiro CM. Predictors of impaired daytime sleep and wakefulness in patients with Parkinson disease treated with older (ergot) vs newer (nonergot) dopamine agonists. Arch Neurol 2004 Jan; 61(1): 97–102PubMedCrossRefGoogle Scholar
  42. 42.
    Arnold G. Falling asleep at the wheel: motor vehicle mishaps in people taking pramipexole and ropinirole. Neurology 2000 Jan 11; 54(1): 275–6; author reply 6-7PubMedGoogle Scholar
  43. 43.
    Hauser RA, Gauger L, Anderson WM, et al. Pramipexole-induced somnolence and episodes of daytime sleep. Mov Disord 2000 Jul; 15(4): 658–63PubMedCrossRefGoogle Scholar
  44. 44.
    Ryan M, Slevin JT, Wells A. Non-ergot dopamine agonist-induced sleep attacks. Pharmacotherapy 2000 Jun; 20(6): 724–6PubMedCrossRefGoogle Scholar
  45. 45.
    Roth T, Rye DB, Borchert LD, et al. Assessment of sleepiness and unintended sleep in Parkinson’s disease patients taking dopamine agonists. Sleep Med 2003 Jul; 4(4): 275–80PubMedCrossRefGoogle Scholar
  46. 46.
    Braga-Neto P, da Silva-Junior FP, Sueli Monte F, et al. Snoring and excessive daytime sleepiness in Parkinson’s disease. J Neurol Sci 2004 Jan 15; 217(1): 41–5PubMedCrossRefGoogle Scholar
  47. 47.
    Naoshi S, Hiroshi S, Masato K. Evaluation of excessive daytime sleepiness in patients with Parkinson’s disease: study of symptoms and treatments by using Epworth Sleepiness Scale score. St Marianna Med J 2004; 32(6): 535–50Google Scholar
  48. 48.
    Paus S, Brecht HM, Koster J, et al. Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson’s disease. Mov Disord 2003 Jun; 18(6): 659–67PubMedCrossRefGoogle Scholar
  49. 49.
    Wood LD. Clinical review and treatment of select adverse effects of dopamine receptor agonists in Parkinson’s disease. Drugs Aging 2010 Apr 1; 27(4): 295–310PubMedCrossRefGoogle Scholar
  50. 50.
    Chaudhuri KR, Pal S, Brefel-Courbon C. ‘Sleep attacks’ or ‘unintended sleep episodes’ occur with dopamine agonists: is this a class effect? Drug Saf 2002; 25(7): 473–83PubMedCrossRefGoogle Scholar
  51. 51.
    Haq Z, Naidu Y, Reddy P, et al. Narcolepsy in Parkinson’s disease. Expert Rev Neurother 2010; 10(6): 879–84PubMedCrossRefGoogle Scholar
  52. 52.
    Andreu N, Chale JJ, Senard JM, et al. L-Dopa-induced sedation: a double-blind cross-over controlled study versus triazolam and placebo in healthy volunteers. Clin Neuropharmacol 1999 Jan-Feb; 22(1): 15–23PubMedCrossRefGoogle Scholar
  53. 53.
    Ferreira JJ, Galitzky M, Montastruc JL, et al. Sleep attacks and Parkinson’s disease treatment. Lancet 2000 Apr 15; 355(9212): 1333–4PubMedCrossRefGoogle Scholar
  54. 54.
    Silkis IG. Search for approaches to correction of daytime sleepiness induced by dopaminergic drugs during treatment of Parkinson’s disease: neurochemical aspects. J Neurochem 2009; 3(3): 221–31CrossRefGoogle Scholar
  55. 55.
    Arnulf I, Bonnet AM, Damier P, et al. Hallucinations, REM sleep, and Parkinson’s disease: a medical hypothesis. Neurology 2000 Jul 25; 55(2): 281–8PubMedCrossRefGoogle Scholar
  56. 56.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991 Dec; 14(6): 540–5PubMedGoogle Scholar
  57. 57.
    Hagell P, Broman JE. Measurement properties and hierarchical item structure of the Epworth Sleepiness Scale in Parkinson’s disease. J Sleep Res 2007 Mar; 16(1): 102–9PubMedCrossRefGoogle Scholar
  58. 58.
    Hobson DE, Lang AE, Martin WR, et al. Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group. JAMA 2002 Jan 23–30; 287(4): 455–63PubMedCrossRefGoogle Scholar
  59. 59.
    Meindorfner C, Korner Y, Moller JC, et al. Driving in Parkinson’s disease: mobility, accidents, and sudden onset of sleep at the wheel. Mov Disord 2005 Jul; 20(7): 832–42PubMedCrossRefGoogle Scholar
  60. 60.
    Martinez-Martin P, Visser M, Rodriguez-Blazquez C, et al. SCOPA-sleep and PDSS: two scales for assessment of sleep disorder in Parkinson’s disease. Mov Disord 2008 Sep 15; 23(12): 1681–8PubMedCrossRefGoogle Scholar
  61. 61.
    Chaudhuri KR, Ellis C, Love-Jones S, et al. Postprandial hypotension and parkinsonian state in Parkinson’s disease. Mov Disord 1997 Nov; 12(6): 877–84PubMedCrossRefGoogle Scholar
  62. 62.
    van Hilten JJ, Weggeman M, van der Velde EA, et al. Sleep, excessive daytime sleepiness and fatigue in Parkinson’s disease. J Neural Transm Park Dis Dement Sect 1993; 5(3): 235–44PubMedCrossRefGoogle Scholar
  63. 63.
    Chaudhuri KR, Prieto-Jurcynska C, Naidu Y, et al. The nondeclaration of nonmotor symptoms of Parkinson’s disease to health care professionals: an international study using the nonmotor symptoms questionnaire. Mov Disord 2010 Apr 30; 25(6): 697–701CrossRefGoogle Scholar
  64. 64.
    Visser M, van Rooden SM, Verbaan D, et al. A comprehensive model of health-related quality of life in Parkinson’s disease. J Neurol 2008 Oct; 255(10): 1580–7PubMedCrossRefGoogle Scholar
  65. 65.
    Uc EY, Rizzo M, Anderson SW, et al. Driving with distraction in Parkinson disease. Neurology 2006 Nov 28; 67(10): 1774–80PubMedCrossRefGoogle Scholar
  66. 66.
    Happe S, Berger K. The association of dopamine agonists with daytime sleepiness, sleep problems and quality of life in patients with Parkinson’s disease: a prospective study. J Neurol 2001 Dec; 248(12): 1062–7PubMedCrossRefGoogle Scholar
  67. 67.
    Schapira AH. Sleep attacks (sleep episodes) with pergolide. Lancet 2000 Apr 15; 355(9212): 1332–3PubMedCrossRefGoogle Scholar
  68. 68.
    Poewe W, Rascol O, Quinn N, et al. Efficacy of pramipexole and transdermal rotigotine in advanced Parkinson’s disease: a double-blind, double-dummy, randomised controlled trial. Lancet Neurol 2007; 6(6): 513–20PubMedCrossRefGoogle Scholar
  69. 69.
    Zesiewicz TA, Hauser RA. Sleep attacks and dopamine agonists for Parkinson’s disease: what is currently known? CNS Drugs 2003; 17(8): 593–600PubMedCrossRefGoogle Scholar
  70. 70.
    Caap-Ahlgren M, Dehlin O. Insomnia and depressive symptoms in patients with Parkinson’s disease: relationship to health-related quality of life —an interview study of patients living at home. Arch Gerontol Geriatr 2001 Feb; 32(1): 23–33PubMedCrossRefGoogle Scholar
  71. 71.
    Wagner ML, Fedak MN, Sage JI, et al. Complications of disease and therapy: a comparison of younger and older patients with Parkinson’s disease. Ann Clin Lab Sci 1996 Sep–Oct; 26(5): 389–95PubMedGoogle Scholar
  72. 72.
    Factor SA, McAlarney T, Sanchez-Ramos JR, et al. Sleep disorders and sleep effect in Parkinson’s disease. Mov Disord 1990; 5(4): 280–5PubMedCrossRefGoogle Scholar
  73. 73.
    Karlsen K, Larsen JP, Tandberg E, et al. Fatigue in patients with Parkinson’s disease. Mov Disord 1999 Mar; 14(2): 237–41PubMedCrossRefGoogle Scholar
  74. 74.
    Dhawan V, Healy DG, Pal S, et al. Sleep-related problems of Parkinson’s disease. Age Ageing 2006 May; 35(3): 220–8PubMedCrossRefGoogle Scholar
  75. 75.
    Winge K, Werdelin LM, Nielsen KK, et al. Effects of dopaminergic treatment on bladder function in Parkinson’s disease. Neurourol Urodyn 2004; 23(7): 689–96PubMedCrossRefGoogle Scholar
  76. 76.
    Naidu Y, Chaudhuri KR. Transdermal rotigotine: a new non-ergot dopamine agonist for the treatment of Parkinson’s disease. Expert Opin Drug Deliv 2007; 4(2): 111–8PubMedCrossRefGoogle Scholar
  77. 77.
    Zarcone V, Kryger MH, Roth T, et al., editors. Principles and practice of sleep medicine. 3rd ed. Philadelphia (PA): Saunders, 2000Google Scholar
  78. 78.
    Dorsey CM, Lukas SE, Teicher MH, et al. Effects of passive body heating on the sleep of older female insomniacs. J Geriatr Psychiatry Neurol 1996 Apr; 9(2): 83–90PubMedGoogle Scholar
  79. 79.
    Dorsey CM, Teicher MH, Cohen-Zion M, et al. Core body temperature and sleep of older female insomniacs before and after passive body heating. Sleep 1999 Nov 1; 22(7): 891–8PubMedGoogle Scholar
  80. 80.
    Tandberg E, Larsen JP, Karlsen K. A community-based study of sleep disorders in patients with Parkinson’s disease. Mov Disord 1998 Nov; 13(6): 895–9PubMedCrossRefGoogle Scholar
  81. 81.
    Rogers AE, Aldrich MS, Lin X. A comparison of three different sleep schedules for reducing daytime sleepiness in narcolepsy. Sleep 2001 Jun 15; 24(4): 385–91PubMedGoogle Scholar
  82. 82.
    Wisor JP, Nishino S, Sora I, et al. Dopaminergic role in stimulant-induced wakefulness. J Neurosci 2001 Mar 1; 21(5): 1787–94PubMedGoogle Scholar
  83. 83.
    Hogl B, Saletu M, Brandauer E, et al. Modafinil for the treatment of daytime sleepiness in Parkinson’s disease: a double-blind, randomized, crossover, placebo-controlled polygraphic trial. Sleep 2002 Dec; 25(8): 905–9PubMedGoogle Scholar
  84. 84.
    Ondo WG, Fayle R, Atassi F, et al. Modafinil for daytime somnolence in Parkinson’s disease: double blind, placebo controlled parallel trial. J Neurol Neurosurg Psychiatry 2005 Dec; 76(12): 1636–9PubMedCrossRefGoogle Scholar
  85. 85.
    Kumar R. Approved and investigational uses of modafinil: an evidence-based review. Drugs 2008; 68(13): 1803–39PubMedCrossRefGoogle Scholar
  86. 86.
    Comella CL. Sleep disturbances in Parkinson’s disease. Curr Neurol Neurosci Rep 2003 Mar; 3(2): 173–80PubMedCrossRefGoogle Scholar
  87. 87.
    Hansard MJ, Smith LA, Jackson MJ, et al. Dopamine, but not norepinephrine or serotonin, reuptake inhibition reverses motor deficits in 1-methyl-4-phenyl-1,2,3,6-tetra-hydropyridine-treated primates. J Pharmacol Exp Ther 2002 Dec; 303(3): 952–8PubMedCrossRefGoogle Scholar
  88. 88.
    Ondo WG, Perkins T, Swick T, et al. Sodium oxybate for excessive daytime sleepiness in Parkinson disease: an open-label polysomnographic study. Arch Neurol 2008 Oct; 65(10): 1337–40PubMedCrossRefGoogle Scholar
  89. 89.
    Mamelak M, Black J, Montplaisir J, et al. A pilot study on the effects of sodium oxybate on sleep architecture and daytime alertness in narcolepsy. Sleep 2004 Nov 1; 27(7): 1327–34PubMedGoogle Scholar
  90. 90.
    Hechler V, Gobaille S, Bourguignon JJ, et al. Extracellular events induced by gamma-hydroxybutyrate in striatum: a microdialysis study. J Neurochem 1991 Mar; 56(3): 938–44PubMedCrossRefGoogle Scholar
  91. 91.
    Szabo ST, Gold MS, Goldberger BA, et al. Effects of sustained gamma-hydroxybutyrate treatments on spontaneous and evoked firing activity of locus coeruleus norepinephrine neurons. Biol Psychiatry 2004 May 1; 55(9): 934–9PubMedCrossRefGoogle Scholar
  92. 92.
    Lopiano L, Rizzone M, Bergamasco B, et al. Daytime sleepiness improvement following bilateral chronic electrical stimulation of the subthalamic nucleus in Parkinson’s disease. Eur Neurol 2001; 46(1): 49–50PubMedCrossRefGoogle Scholar
  93. 93.
    Rye DB, Dempsay J, Dihenia B. REM-sleep dyscontrol in Parkinson’s disease: case report of effects of elective pallidotomy. Sleep Res 1997; 26: 591Google Scholar
  94. 94.
    Rye DB. Excessive daytime sleepiness and unintended sleep in Parkinson’s disease. Curr Neurol Neurosci Rep 2006 Mar; 6(2): 169–76PubMedCrossRefGoogle Scholar
  95. 95.
    Zesiewicz TA, Sullivan KL, Arnulf I, et al. Practice parameter: treatment of nonmotor symptoms of Parkinson disease —report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010 Mar 16; 74(11): 924–31PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Bettina Knie
    • 1
  • M. Tanya Mitra
    • 2
  • Kartik Logishetty
    • 2
  • K. Ray Chaudhuri
    • 3
    • 4
  1. 1.Charité Universitätsmedizin BerlinBerlinGermany
  2. 2.King’s College London Medical SchoolLondonUK
  3. 3.National Parkinson Foundation Centre of Excellence, King’s College HospitalUniversity Hospital LewishamLondonUK
  4. 4.Institute of PsychiatryKing’s College LondonLondonUK
  5. 5.King’s College Hospital, Denmark HillLondonUK

Personalised recommendations