Twenty Years After: Another Case Report of Melatonin Effects on REM Sleep Behavior Disorder, Using Serial Dopamine Transporter Imaging

2017 ◽  
Vol 76 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Dieter Kunz ◽  
Frederik Bes
2021 ◽  
pp. 1-6
Author(s):  
Oliver Steiner ◽  
Jan de Zeeuw ◽  
Sophia Stotz ◽  
Frederik Bes ◽  
Dieter Kunz

Neurodegenerative processes in the brain are reflected by structural retinal changes. As a possible biomarker of cognitive state in prodromal α-synucleinopathies, we compared melanopsin-mediated post-illumination pupil responses (PIPR) with cognition (CERAD-plus) in 69 patients with isolated REM-sleep behavior disorder. PIPR was significantly correlated with cognitive domains, especially executive functioning (r = 0.417, p <  0.001), which was more pronounced in patients with lower dopamine-transporter density, suggesting advanced neurodegenerative state (n = 26; r = 0.575, p = 0.002). Patients with mild neurocognitive disorder (n = 10) had significantly reduced PIPR (smaller melanopsin-mediated response) compared to those without (p = 0.001). Thus, PIPR may be a functional—possibly monitoring—marker for impaired cognitive state in (prodromal) α-synucleinopathies.


2019 ◽  
Vol 8 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Seyed Mostafa Mansouripour ◽  
Dharmendra Kumar

Background: REM sleep behavior disorder (RBD) is manifested by abnormal motor behavior with an endurance of tone during REM sleep. Studies suggest that patients taking Selective serotonin reuptake inhibitors (SSRIs) are at greater risk of developing REM sleep behavior disorder. Case Presentation: We present a case of 39-year-old female with a past medical history of spinal cord injury from a gunshot wound 19 years ago resulting in paraplegia, posttraumatic stress disorder(PTSD), chronic pain, and chronic sleep problem. After sertraline started and up-titrated to 200 mg for her anxiety, she noticed worsening of her nighttime sleep behavior. Her mother also witnessed sleepwalking episode and doing things which the patient had no recollection in the morning, including trying to take a bath and eat from the refrigerator. On her follow-up appointment, her sertraline was discontinued altogether and she was started on Escitalopram 5 mg. She tolerated the medication well, it helped moderately with her anxiety and by the time of this case report (approximately 1 month) patient did not report any sleep-related behavior. Conclusion: Since antidepressant medication is very commonly prescribed, it is important to be cautious of physiologic changes they may induce, even if the clinical significance of these changes is not fully elucidated. In addition, RBD may predict neurodegenerative disorders a couple of years earlier, so it may be used as an effective early marker of neurodegenerative diseases.


2018 ◽  
Vol 17 (1) ◽  
pp. 155-157 ◽  
Author(s):  
Michiko Konno ◽  
Takahiro Suzuki ◽  
Tadashi Kanamori ◽  
Ryuji Furihata ◽  
Hiromi Yokose ◽  
...  

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Petr Dušek ◽  
Veronika Lorenzo y Losada Ibarburu ◽  
Ondrej Bezdicek ◽  
Irene Dall’antonia ◽  
Simona Dostálová ◽  
...  

Abstract The aim of this study was to evaluate associations of motor and non-motor symptoms with dopamine transporter binding in prodromal stage of synucleinopathies. We examined 74 patients with idiopathic REM sleep behavior disorder (RBD), which is a prodromal synucleinopathy, and 39 controls using Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment, University of Pennsylvania Smell Identification Test (UPSIT), Farnsworth-Munsell 100 hue test, orthostatic test, Scales for Outcomes in PD-Autonomic, Beck depression inventory-II, State-Trait Anxiety Inventory, and video-polysomnography. Electromyographic muscle activity during REM sleep was quantified according to Sleep Innsbruck-Barcelona criteria. In 65 patients, dopamine transporter single-photon emission computed tomography (DAT-SPECT) imaging was performed, putaminal binding ratio was calculated and scans were classified as normal, borderline, or abnormal. Compared to controls, RBD patients had significantly more severe scores in all examined tests. Patients with abnormal DAT-SPECT had higher MDS-UPDRS motor score (p = 0.006) and higher prevalence of orthostatic hypotension (p = 0.008). Putaminal binding ratio was positively associated with UPSIT score (p = 0.03) and negatively associated with tonic (p = 0.003) and phasic (p = 0.01) muscle activity during REM sleep. These associations likely reflect simultaneous advancement of underlying pathology in substantia nigra and susceptible brainstem and olfactory nuclei in prodromal synucleinopathy.


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