Abnormal Intracortical Functions in Parkinson’s Disease with Rapid Eye Movement Sleep Behaviour Disorder

Bhattacharya, Amitabh; Kamble, Nitish; Yadav, Ravi; Stezin, Albert; Pal, Pramod Kumar

doi:10.1017/cjn.2021.206

Cited by 6 publications

(7 citation statements)

References 38 publications

(50 reference statements)

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“…Research has shown that clinical PD patients with RBD had more profound inhibition of SICI and lower intensity of ICF than those without RBD ( 18 ). This finding might lead to the thought that additional and widespread electrophysiological deficits would present when clinical PD is comorbid with RBD.…”

Section: Discussionmentioning

confidence: 99%

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Cortical excitability in patients with REM sleep behavior disorder with abnormal TRODAT-1 SPECT scan: an insight into prodromal Parkinson’s disease

Chen

et al. 2023

Front. Neurol.

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IntroductionREM Sleep Behavior Disorder (RBD) has been highlighted to identify a patient with prodromal Parkinson’s disease (PD). Although many studies focus on biomarkers to predict an RBD patient’s evolution from prodromal PD to clinical PD, the neurophysiological perturbation of cortical excitability has not yet been well elucidated. Moreover, no study describes the difference between RBD with and without abnormal TRODAT-1 SPECT.MethodsBy measuring the amplitude of motor evoked potentials (MEP), the cortical excitability changes after transcranial magnetic stimulation (TMS) were evaluated in 14 patients with RBD and eight healthy controls (HC). Seven of the 14 patients with RBD showed abnormal TRODAT-1 (TRA-RBD), and seven were normal (TRN-RBD). The tested parameters of cortical excitability include resting motor threshold (RMT), active motor threshold (AMT), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), contralateral silence period (CSP), and input–output recruitment curve.ResultsThe RMT and AMT showed no difference among the three studied groups. There was only SICI at inter-stimuli-interval 3 ms revealing group differences. The TRA-RBD demonstrated significant differences to HC in these aspects: decreased SICI, increased ICF, shortening of CSP, and augmented MEP amplitude at 100% RMT. Moreover, the TRA-RBD had a smaller MEP facilitation ratio at 50% and 100% of maximal voluntary contraction when compared to TRN-RBD. The TRN-RBD did not present any difference to HC.ConclusionWe showed that TRA-RBD shared similar cortical excitability changes with clinical PD. These findings would provide further insight into the concept that RBD is the highly prevalent entity in prodromal PD.

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Section: Discussionmentioning

confidence: 99%

“…In patients with iRBD, the cortical excitability showed decreasing SICI and intracortical facilitation (ICF) intensity ( 15 , 16 ). However, limited reports compared the difference between clinical PD patients with and without RBD ( 17 , 18 ), and the cortical excitability changes in prodromal PD have not yet been well elucidated.…”

Section: Introductionmentioning

confidence: 99%

Cortical excitability in patients with REM sleep behavior disorder with abnormal TRODAT-1 SPECT scan: an insight into prodromal Parkinson’s disease

Chen

et al. 2023

Front. Neurol.

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“…RBD is one of the prodromal symptoms of PD. RBD showed visual hallucinations, dream enactments, muscle twitching during REM sleep, psychosis, autonomic disturbances, and dementia [ 57 ]. Abnormal dream enactments characterize RBD during REM sleep with activities such as punching, waving, swinging wildly, or jumping out of bed [ 77 ].…”

Section: Sleep Disturbances In Parkinson’s Diseasementioning

confidence: 99%

“…With the help of transcranial magnetic stimulation, Bhattacharya and co-workers evaluated neurophysiological abnormalities in PD patients with and without RBD. The PD-RBD patients showed significantly strong inhibition of intracortical facilitation, glutamatergic transmission, and enhanced GABAergic transmission [ 57 ].…”

Section: Evaluation Of Sleep Disordersmentioning

confidence: 99%

Neurological Insights into Sleep Disorders in Parkinson’s Disease

et al. 2023

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Parkinson’s disease (PD) is a common multidimensional neurological disorder characterized by motor and non-motor features and is more prevalent in the elderly. Sleep disorders and cognitive disturbances are also significant characteristics of PD. Sleep is an important physiological process for normal human cognition and physical functioning. Sleep deprivation negatively impacts human physical, mental, and behavioral functions. Sleep disturbances include problems falling asleep, disturbances occurring during sleep, abnormal movements during sleep, insufficient sleep, and excessive sleep. The most recognizable and known sleep disorders, such as rapid-eye-movement behavior disorder (RBD), insomnia, excessive daytime sleepiness (EDS), restless legs syndrome (RLS), sleep-related breathing disorders (SRBDs), and circadian-rhythm-related sleep–wake disorders (CRSWDs), have been associated with PD. RBD and associated emotional disorders are common non-motor symptoms of PD. In individuals, sleep disorders and cognitive impairment are important prognostic factors for predicting progressing neurodegeneration and developing dementia conditions in PD. Studies have focused on RBD and its associated neurological changes and functional deficits in PD patients. Other risks, such as cognitive decline, anxiety, and depression, are related to RBD. Sleep-disorder diagnosis is challenging, especially in identifying the essential factors that disturb the sleep–wake cycle and the co-existence of other concomitant sleep issues, motor symptoms, and breathing disorders. Focusing on sleep patterns and their disturbances, including genetic and other neurochemical changes, helps us to better understand the central causes of sleep alterations and cognitive functions in PD patients. Relations between α-synuclein aggregation in the brain and gender differences in sleep disorders have been reported. The existing correlation between sleep disorders and levels of α-synuclein in the cerebrospinal fluid indicates the risk of progression of synucleinopathies. Multidirectional approaches are required to correlate sleep disorders and neuropsychiatric symptoms and diagnose sensitive biomarkers for neurodegeneration. The evaluation of sleep pattern disturbances and cognitive impairment may aid in the development of novel and effective treatments for PD.

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“… 110 Finally, another report has recently compared PD without and with RBD: an enhancement of GABA-mediated and a reduction of glutamine-mediated activity was found in PDRBD only, thus suggesting a distinctive physiopathological processes in these subjects. 111 …”

Section: Neurophysiological Biomarkers Of Neurodegeneration In Rbdmentioning

confidence: 99%

Considering REM Sleep Behavior Disorder in the Management of Parkinson’s Disease

Figorilli¹,

Meloni²,

Lanza³

et al. 2023

NSS

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Rapid eye movement (REM) sleep behavior disorder (RBD) is the result of the loss of physiological inhibition of muscle tone during REM sleep, characterized by dream-enacting behavior and widely recognized as a prodromal manifestation of alpha-synucleinopathies. Indeed, patients with isolated RBD (iRBD) have an extremely high estimated risk to develop a neurodegenerative disease after a long follow up. Nevertheless, in comparison with PD patients without RBD (PDnoRBD), the occurrence of RBD in the context of PD (PDRBD) seems to identify a unique, more malignant phenotype, characterized by a more severe burden of disease in terms of both motor and non-motor symptoms and increased risk for cognitive decline. However, while some medications (eg, melatonin, clonazepam, etc.) and non-pharmacological options have been found to have some therapeutic benefits on RBD there is no available treatment able to modify the disease course or, at least, slow down the neurodegenerative process underlying phenoconversion. In this scenario, the long prodromal phase may allow an early therapeutic window and, therefore, the identification of multimodal biomarkers of disease onset and progression is becoming increasingly crucial. To date, several clinical (motor, cognitive, olfactory, visual, and autonomic features) neurophysiological, neuroimaging, biological (biofluids or tissue biopsy), and genetic biomarkers have been identified and proposed, also in combination, as possible diagnostic or prognostic markers, along with a potential role for some of them as outcome measures and index of treatment response. In this review, we provide an insight into the present knowledge on both existing and future biomarkers of iRBD and highlight the difference with PDRBD and PDnoRBD, including currently available treatment options.

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Abnormal Intracortical Functions in Parkinson’s Disease with Rapid Eye Movement Sleep Behaviour Disorder

Cited by 6 publications

References 38 publications

Cortical excitability in patients with REM sleep behavior disorder with abnormal TRODAT-1 SPECT scan: an insight into prodromal Parkinson’s disease

Cortical excitability in patients with REM sleep behavior disorder with abnormal TRODAT-1 SPECT scan: an insight into prodromal Parkinson’s disease

Neurological Insights into Sleep Disorders in Parkinson’s Disease

Considering REM Sleep Behavior Disorder in the Management of Parkinson’s Disease

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