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P3.174 Laughing during sleep as a manifestation of rapid eye movement sleep behaviour disorder
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
The FG reached the DA neurons within the so-called A11 group but didn’t target to any other DA neurons group. These neurons were located ventrally in the posterior hypothalamus adjacent to the periventricular region. Conclusion: The diencephalic A11 area is the sole dopaminergic group to project to the spinal cord in the non-human primate where it modulates sensory-motor integration through D2 and D3 receptor subtypes. This may explain the high potency of dopaminergic D2/ D3 agonists in the relief of RLS symptoms. P3.174 Laughing during sleep as a manifestation of rapid eye movement sleep behaviour disorder F. Siclari, M. Wienecke, R. Poryazova, D. Waldvogel, C. Bassetti, C. Baumann. Neurology, University Hospital Zurich, Zurich, Switzerland
S193
placebo-controlled trial in RLS, lisuride and ropinirole proved to be superior to placebo (IRLS total scores), with lisuride being superior also over ropinirole in secondary parameters. No unexpected adverse events of clinical significance occurred in altogether 305 patients on lisuride. Transdermal lisuride was well tolerated apart from reversible application site reactions and appears as a highly valuable RLS treatment. P3.176 Idiopathic restless legs syndrome in Parkinson’s disease – a risk factor or a chance association? 1 M. Boczarska-Jedynak1 , M. Sałata2 , B. Jasinska-Myga ´ , G. Opala1 . 1 Department of Neurology, Silesian Medical Academy, Central University Hospital, 2 Students’ Scientific Organization at the Department of Neurology, Silesian Medical Academy, Katowice, Poland
Background: Among the wide range of sleep-related behaviours displayed by patients with rapid eye movement (REM) sleep behavior disorder (RBD), aggressive and violent acts are particularly common, while non-aggressive, pleasant behaviours including laughter have been reported rarely. Methods: We retrospectively reviewed all consecutive polysomnographic recordings between 2004 and 2008 of patients who met the diagnostic criteria for RBD, and describe 6 patients who repeatedly laughed during REM sleep. Results: Of the 6 patients (3 males), 3 had idiopathic Parkinson’s disease, and 3 suffered from multisystem atrophy. Mean age was 59±12 years, mean disease duration was 10±12 years. Other behaviours observed during REM sleep included smiling, crying, aggressive behaviour, screaming, and somniloquia. Five of 6 patients were severely depressed during daytime. One patient suffered from cognitive disturbances, and one from daytime hallucinations. Five patients were treated with levodopa, one with a dopaminergic agonist, one patient had no dopaminergic treatment, and 2 patients took antidepressant drugs. Conclusion: Laughing belongs to the clinical spectrum of RBD, irrespective of treatment. In our case series, 5 of 6 patients were severely depressed during daytime, which gives way to the hypothesis whether emotional dream content may be dissociated from daytime mood.
The aim of study: Restless Legs Syndrome (RLS) is a chronic disorder caused by dysfunction of dopaminergic transmission in subcortical areas. There is still no evidence that RLS symptoms early in life predispose to develop PD. RLS is a common disorder affecting from 5 to 15% of general population and about 15 to 20% of PD patients. The aim of study is to present five cases of patients who have suffered from idiopathic RLS since childhood or young adult and later have started to present symptoms of PD. Case report: 1 woman and 4 men aged 44–79 (mean – 61.8) have suffered from RLS symptoms since the age of 6–63 (mean – 38.8). Parkinsonian symptoms appeared after 3 to 44 years and finally PD was diagnosed. In three cases family history for RLS was positive. Iron level varied from 90 to 126 mg/dl (mean 106.3). In every case brain MRI did not revealed significant changes. All patients had L-dopa administrated in doses 100–1200 mg/24 h (mean – 570 mg/day), three of them were treated with L-dopa combined with dopamine agonists (ropinirol 0.25 – 1 mg/day). Discussion: RLS may predict the onset of PD. Taking into account the high frequency of RLS in general population it may be only a coincidence of both conditions. RLS still can not be recognized as a predictor of idiopathic PD. Further investigations are needed.
P3.175 Transdermal lisuride is effective in Restless Legs Syndrome (RLS)
D. Carvalho1 , D. Wallace2 , A. Pandey2 , S. Dib2 , H. Moore-Quiroga2 , C. Singer2 . 1 Department of Neurology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2 Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
H. Beneˇs1 , R. Kohnen2 , R. Horowski3 , K.P. Latte´ 3 , D. Palla3 . 1 Somnibene, Institut f¨ ur Medizinische Forschung und Schlafmedizin Schwerin GmbH, Schwerin, 2 RPS Research Germany GmbH (formerly IMEREM GmbH), N¨ urnberg, 3 Axxonis Pharma AG, Berlin, Germany Objectives/background: Transdermal lisuride has been developed to provide long-acting dopaminergic effects in RLS. Methods: In two large clinical trials with transdermal lisuride efficacy, safety and local tolerability of transdermal lisuride was evaluated. Both studies, TULIR 02 (210 patients) and TULIR 03 (300 patients), were double-blind, randomized, placebo-controlled multicenter phase II/III studies. In the case of TULIR 03 oral ropinirole was used as comparator (3 arm study). Patches of 10–40 cm2 were applied every other morning for 12 weeks and change of IRLS score was selected as primary endpoint. Ropinirole was administered every evening (double-dummy design). Results: Significant dose-dependent efficacy was observed (up to a dose of 40 cm2 ) in TULIR 02. In TULIR 03 lisuride and ropinirole were significantly superior to placebo in respect to the IRLS total score. In the responder and remitter rates, lisuride was superior also over ropinirole. In both studies lisuride was significantly superior over placebo also in secondary parameters including QoL. Conclusion: Application of transdermal lisuride resulted in a dosedependent efficacy (at 10 cm2 , pronounced at 20 cm2 with no significant further increase at 40 cm2 ). In the first active- and
P3.177 Sleep-related falling out of bed (SFOB) in Parkinson’s disease. A descriptive analysis
Introduction: Sleep-related falling out of bed (SFOB) has been reported in many conditions, including Parkinson’s disease (PD), where it has been associated to serious injuries. However, there is limited characterization of SFOB in PD. Methods: We performed a retrospective review of 13 patients seen at the University of Miami Movement Disorder Clinic with history of at least one episode of SFOB over the last 5 years documented by a REM Sleep Behavior Disorder screening questionnaire. Results: The mean age of PD onset and at the completion of the questionnaire was 55.8 (±10.8) and 66.1 (±9.2), respectively. The H&Y stage mean was 2.3 (±0.5). Five patients reported only one episode, 2 reported two episodes and 5 reported more than two. Ten patients fulfilled minimal clinical criteria for RBD. Five reported injuries: soft tissue trauma to neck, arms and gluteus (4), and bitten tongue (1). The most prevalent sleep-related symptoms were: vivid dreams (92.3%), phonatory activity (84.6%), being awakened by the movements (76.9%) and “fighting” during sleep (61.5%). Nine patients had history of Anxiety/Depression. Twelve had prior exposure to medication known to induce or aggravate RBD: SSRI’s (7), MAO-I’s (10) and mirtazapine (1). Conclusions: SFOB was highly associated with vivid dreams and history suggestive of RBD. A large proportion of our sample had prior exposure to medications that may influence RBD expression.
The FG reached the DA neurons within the so-called A11 group but didn’t target to any other DA neurons group. These neurons were located ventrally in the posterior hypothalamus adjacent to the periventricular region. Conclusion: The diencephalic A11 area is the sole dopaminergic group to project to the spinal cord in the non-human primate where it modulates sensory-motor integration through D2 and D3 receptor subtypes. This may explain the high potency of dopaminergic D2/ D3 agonists in the relief of RLS symptoms. P3.174 Laughing during sleep as a manifestation of rapid eye movement sleep behaviour disorder F. Siclari, M. Wienecke, R. Poryazova, D. Waldvogel, C. Bassetti, C. Baumann. Neurology, University Hospital Zurich, Zurich, Switzerland
S193
placebo-controlled trial in RLS, lisuride and ropinirole proved to be superior to placebo (IRLS total scores), with lisuride being superior also over ropinirole in secondary parameters. No unexpected adverse events of clinical significance occurred in altogether 305 patients on lisuride. Transdermal lisuride was well tolerated apart from reversible application site reactions and appears as a highly valuable RLS treatment. P3.176 Idiopathic restless legs syndrome in Parkinson’s disease – a risk factor or a chance association? 1 M. Boczarska-Jedynak1 , M. Sałata2 , B. Jasinska-Myga ´ , G. Opala1 . 1 Department of Neurology, Silesian Medical Academy, Central University Hospital, 2 Students’ Scientific Organization at the Department of Neurology, Silesian Medical Academy, Katowice, Poland
Background: Among the wide range of sleep-related behaviours displayed by patients with rapid eye movement (REM) sleep behavior disorder (RBD), aggressive and violent acts are particularly common, while non-aggressive, pleasant behaviours including laughter have been reported rarely. Methods: We retrospectively reviewed all consecutive polysomnographic recordings between 2004 and 2008 of patients who met the diagnostic criteria for RBD, and describe 6 patients who repeatedly laughed during REM sleep. Results: Of the 6 patients (3 males), 3 had idiopathic Parkinson’s disease, and 3 suffered from multisystem atrophy. Mean age was 59±12 years, mean disease duration was 10±12 years. Other behaviours observed during REM sleep included smiling, crying, aggressive behaviour, screaming, and somniloquia. Five of 6 patients were severely depressed during daytime. One patient suffered from cognitive disturbances, and one from daytime hallucinations. Five patients were treated with levodopa, one with a dopaminergic agonist, one patient had no dopaminergic treatment, and 2 patients took antidepressant drugs. Conclusion: Laughing belongs to the clinical spectrum of RBD, irrespective of treatment. In our case series, 5 of 6 patients were severely depressed during daytime, which gives way to the hypothesis whether emotional dream content may be dissociated from daytime mood.
The aim of study: Restless Legs Syndrome (RLS) is a chronic disorder caused by dysfunction of dopaminergic transmission in subcortical areas. There is still no evidence that RLS symptoms early in life predispose to develop PD. RLS is a common disorder affecting from 5 to 15% of general population and about 15 to 20% of PD patients. The aim of study is to present five cases of patients who have suffered from idiopathic RLS since childhood or young adult and later have started to present symptoms of PD. Case report: 1 woman and 4 men aged 44–79 (mean – 61.8) have suffered from RLS symptoms since the age of 6–63 (mean – 38.8). Parkinsonian symptoms appeared after 3 to 44 years and finally PD was diagnosed. In three cases family history for RLS was positive. Iron level varied from 90 to 126 mg/dl (mean 106.3). In every case brain MRI did not revealed significant changes. All patients had L-dopa administrated in doses 100–1200 mg/24 h (mean – 570 mg/day), three of them were treated with L-dopa combined with dopamine agonists (ropinirol 0.25 – 1 mg/day). Discussion: RLS may predict the onset of PD. Taking into account the high frequency of RLS in general population it may be only a coincidence of both conditions. RLS still can not be recognized as a predictor of idiopathic PD. Further investigations are needed.
P3.175 Transdermal lisuride is effective in Restless Legs Syndrome (RLS)
D. Carvalho1 , D. Wallace2 , A. Pandey2 , S. Dib2 , H. Moore-Quiroga2 , C. Singer2 . 1 Department of Neurology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2 Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
H. Beneˇs1 , R. Kohnen2 , R. Horowski3 , K.P. Latte´ 3 , D. Palla3 . 1 Somnibene, Institut f¨ ur Medizinische Forschung und Schlafmedizin Schwerin GmbH, Schwerin, 2 RPS Research Germany GmbH (formerly IMEREM GmbH), N¨ urnberg, 3 Axxonis Pharma AG, Berlin, Germany Objectives/background: Transdermal lisuride has been developed to provide long-acting dopaminergic effects in RLS. Methods: In two large clinical trials with transdermal lisuride efficacy, safety and local tolerability of transdermal lisuride was evaluated. Both studies, TULIR 02 (210 patients) and TULIR 03 (300 patients), were double-blind, randomized, placebo-controlled multicenter phase II/III studies. In the case of TULIR 03 oral ropinirole was used as comparator (3 arm study). Patches of 10–40 cm2 were applied every other morning for 12 weeks and change of IRLS score was selected as primary endpoint. Ropinirole was administered every evening (double-dummy design). Results: Significant dose-dependent efficacy was observed (up to a dose of 40 cm2 ) in TULIR 02. In TULIR 03 lisuride and ropinirole were significantly superior to placebo in respect to the IRLS total score. In the responder and remitter rates, lisuride was superior also over ropinirole. In both studies lisuride was significantly superior over placebo also in secondary parameters including QoL. Conclusion: Application of transdermal lisuride resulted in a dosedependent efficacy (at 10 cm2 , pronounced at 20 cm2 with no significant further increase at 40 cm2 ). In the first active- and
P3.177 Sleep-related falling out of bed (SFOB) in Parkinson’s disease. A descriptive analysis
Introduction: Sleep-related falling out of bed (SFOB) has been reported in many conditions, including Parkinson’s disease (PD), where it has been associated to serious injuries. However, there is limited characterization of SFOB in PD. Methods: We performed a retrospective review of 13 patients seen at the University of Miami Movement Disorder Clinic with history of at least one episode of SFOB over the last 5 years documented by a REM Sleep Behavior Disorder screening questionnaire. Results: The mean age of PD onset and at the completion of the questionnaire was 55.8 (±10.8) and 66.1 (±9.2), respectively. The H&Y stage mean was 2.3 (±0.5). Five patients reported only one episode, 2 reported two episodes and 5 reported more than two. Ten patients fulfilled minimal clinical criteria for RBD. Five reported injuries: soft tissue trauma to neck, arms and gluteus (4), and bitten tongue (1). The most prevalent sleep-related symptoms were: vivid dreams (92.3%), phonatory activity (84.6%), being awakened by the movements (76.9%) and “fighting” during sleep (61.5%). Nine patients had history of Anxiety/Depression. Twelve had prior exposure to medication known to induce or aggravate RBD: SSRI’s (7), MAO-I’s (10) and mirtazapine (1). Conclusions: SFOB was highly associated with vivid dreams and history suggestive of RBD. A large proportion of our sample had prior exposure to medications that may influence RBD expression.