Distinctive Features of NREM Parasomnia Behaviors in Parkinson’s Disease and Multiple System Atrophy

Abstract

ObjectiveTo characterize parasomnia behaviors on arousal from NREM sleep in Parkinson’s Disease (PD) and Multiple System Atrophy (MSA).MethodsFrom 30 patients with PD, Dementia with Lewy Bodies/Dementia associated with PD, or MSA undergoing nocturnal video-polysomnography for presumed dream enactment behavior, we were able to select 2 PD and 2 MSA patients featuring NREM Parasomnia Behviors (NPBs). We identified episodes during which the subjects seemed to enact dreams or presumed dream-like mentation (NPB arousals) versus episodes with physiological movements (no-NPB arousals). A time-frequency analysis (Morlet Wavelet Transform) of the scalp EEG signals around each NPB and no- NPB arousal onset was performed, and the amplitudes of the spectral frequencies were compared between NPB and no-NPB arousals.Results19 NPBs were identified, 12 of which consisting of ‘elementary’ NPBs while 7 resembling confusional arousals. With quantitative EEG analysis, we found an amplitude reduction in the 5-6 Hz band 40 seconds before NPBs arousal as compared to no-NPB arousals at F4 and C4 derivations (p<0.01).ConclusionsMany PD and MSA patients feature various NREM sleep-related behaviors, with clinical and electrophysiological differences and similarities with arousal parasomnias in the general population.SignificanceThis study help bring to attention an overlooked phenomenon in neurodegenerative diseases.

Clinical Perspectives of Parkinson's Disease for Ophthalmologists, Otorhinolaryngologists, Cardiologists, Dentists, Gastroenterologists, Urologists, Physiatrists, and Psychiatrists

“… 15 Non-REM parasomnias, such as vivid dreams, nightmares, night terrors, nocturnal hallucinations, confusional arousals or arousal-related episodes mimicking RBD can also occur in patients with PD. 31 32 The cholinergic changes in the brainstem and brainstem-subcortical circuits have been implicated in the development of parasomnias in patients with PD. 31 33 Certain drugs that include selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, and tricyclic antidepressant can trigger both RBD and non-REM parasomnias.…”

“… 31 32 The cholinergic changes in the brainstem and brainstem-subcortical circuits have been implicated in the development of parasomnias in patients with PD. 31 33 Certain drugs that include selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, and tricyclic antidepressant can trigger both RBD and non-REM parasomnias. 34 RLS, characterized by uncomfortable sensations in the legs, an urge to move, and a transitory decrease after moving, as well as PLMS, rhythmical extension of the big toe and dorsiflexion of the ankle, have been reported in 15%–20% of patients with PD.…”