SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science IV. Sleep Disorders – Parasomnias
0565
BRAIN STRUCTURAL DAMAGE IN IDIOPATHIC REM
SLEEP BEHAVIOR DISORDER
Ferini Strambi L 1 , Cabinio M 2 , Marelli S 1 , Manconi M 1 , Zucconi M 1 ,
Oldani A 1 , Castronovo V 1 , Falini A 2
1
Sleep Disorders Center, University Vita-Salute San Raffaele, Milano,
Italy, 2 Neuroradiology Unit and CERMAC, University Vita-Salute San
Raffaele, Milano, Italy
Introduction: Idiopathic Rapid Eye Movement Sleep Behavior Disorder
(iRBD) often precedes the onset of α-synucleinopathies, as Parkinson
disease (PD) and Dementia with Lewy bodies (DLB). Aim of this
study was to assess in vivo the presence of brain abnormalities in iRBD
patients. We evaluated both grey matter (GM) and white matter (WM)
by Magnetic Resonance Imaging (MRI) and Diffusion Tensor Imaging
(DTI) and we made comparisons between iRBD and age-matched controls.
Methods: We studied 10 iRBD patients (9 males, 1 female, mean age=
68.6 years, mean age of RBD onset = 61.1 years) and 16 age- and gendermatched
control subjects (10 males, 6 females, mean age= 64.8 years).
Each patient underwent a complete neurological interview and examination
to assess the presence of clinical features suggestive for RBD, and
to exclude any other sleep disturbance. To confirm the iRBD diagnosis,
all patients underwent full nocturnal polysomnographic (PSG) recording.
We acquired high-resolution anatomical images of WM and GM
and performed whole-brain comparisons between iRBD and control
subjects. We used Voxel-Based Morphometry (VBM) to study the cortical
volume and we analyzed DTI images using Tract-Based Spatial Statistic
(TBSS) to evaluate WM microstructure. Probabilistic tractography
was used to identify the WM tracts involved in the pathology.
Results: iRBD patients showed significant reduction of fractional anisotropy
(FA) in the right parieto-temporal area, which is compatible
with an involvement of the Superior Longitudinal Fasciculus (SLF).
Using VBM, iRBD patients had a significant decrease of GM volume
the right supramarginal gyrus (BA 40), a region anatomically close to
the area with reduced FA. These results are consistent with published
clinical data, reporting an impairment in visuo-spatial abilities in RBD
patients, but also with the hypothesis of a link between iRBD and
α-synucleinopathies given the observation of parieto-occipito-temporal
damages both in non-demented PD and DLB patients.
Conclusion: iRBD patients showed changes in grey and white matter
regions known to be involved in visuo-spatial abilities and that exhibit
neurodegenerative pathology in early PD or DLB. Our results suggest
that iRBD-related abnormalities can be detected in vivo with VBM and
DTI, widely available MRI techniques.
Support (If Any): Study supported by Grant RF07-UNIFI/2.
0566
MOTOR IMPROVEMENT DURING RBD IN MSA
Cochen De Cock V 1,2 , Debs R 2 , Oudiette D 3 , Leu-Semenescu S 3 ,
Bayard S 1 , Vidailhet M 3 , Rascol O 2 , Dauvilliers Y 1 , Arnulf I 3
1
Neurology, CHU de Montpellier, Montpellier, France, 2 Neurology,
Hôpital Purpan, Toulouse, France, 3 Neurology, Pitié Salêptrière, Paris,
France
Introduction: Multiple system atrophy (MSA) is an atypical parkinsonism
characterised by severe motor disabilities that are poorly levodoparesponsive.
Most patients develop REM sleep behavior disorder (RBD).
Because parkinsonism is absent during RBD in patients with Parkinson’s
disease, we studied the movements of patients with MSA during
REM sleep.
Methods: Forty-nine non-demented patients with MSA and 49 patients
with idiopathic Parkinson’s disease were interviewed along with their
98 bed partners using a structured questionnaire. They rated the quality
of movements, vocal and facial expressions during rapid eye movement
sleep behavior disorder as better than, equal to, or worse than the same
activities in an awake state. Sleep and movements were monitored using
video-polysomnography in 22/49 patients with MSA and in 19/49 patients
with Parkinson’s disease. These recordings were analysed for the
presence of parkinsonism and cerebellar syndrome during REM sleep
movements.
Results: Clinical RBD was observed in 43/49 (88%) patients with
MSA. Reports from the 31/43 bed partners who were able to evaluate
movements during sleep indicate that 81% of the patients showed some
form of improvement during RBD. These included improved movement
(73% of patients; faster, 67%; stronger, 52%; and smoother, 26%), improved
speech (59% of patients; louder, 55%; more intelligible, 17%;
and better articulated, 36%), and normalised facial expression (50% of
patients). The rate of improvement was higher in Parkinson’s disease
than in MSA, but no further difference was observed between the two
forms of MSA(predominant parkinsonism vs. cerebellar syndrome).
Video-monitored movements during REM sleep in patients with MSA
revealed more expressive faces, and movements that were faster and
more ample in comparison to facial expression and movements during
wakefulness. These movements were still somewhat jerky but lacked
any visible parkinsonism. Cerebellar signs were not assessable.
Conclusion: We conclude that parkinsonism also disappears during
RBD in patients with MSA, but this improvement is not due to enhanced
dopamine transmission because these patients are not levodopasensitive.
These data suggest that these movements are not influenced by
extrapyramidal regions; however, the influence of abnormal cerebellar
control remains unclear. The transient disappearance of parkinsonism
here is all the more surprising since no treatment (even dopaminergic)
provides a real benefit in this disabling disease.
Support (If Any): The trial was sponsored in part by grants from la
Fondation pour la Recherche Clinique.
0567
REM BEHAVIOR DISORDER IS ASSOCIATED WITH
DEPRESSION IN PARKINSON’S DISEASE
Neikrug AB 1,2 , Liu L 1 , Maglione JE 1 , Natarajan L 3 , Avanzino JA 1 ,
Calderon J 1 , Corey-Bloom J 4,5 , Loredo JS 1,4 , Ancoli-Israel S 1,2
1
Department of Psychiatry, UCSD, La Jolla, CA, USA, 2 Joint Doctoral
Program in Clinical Psychology, SDSU/UCSD, San Diego, CA,
USA, 3 Department of Family and Preventive Medicine, University
of California, San Diego, San Diego, CA, USA, 4 Department of
Medicine, University of California, San Diego, San Diego, CA, USA,
5
Department of Neurosciences, University of California, San Diego,
San Diego, CA, USA
Introduction: REM Behavior Disorder (RBD) and depression are
common and debilitating problems in Parkinson’s disease (PD). To our
knowledge, no study has evaluated the relationship between depression
and objective measures of RBD in PD. We hypothesized that PD patients
with RBD experience more depressive symptoms than PD patients
without RBD.
Methods: 51 PD patients (Men=35; Age=68±9.7yrs) underwent PSG
assessing RBD (REM without atonia; EMGscore=average of tonic and
phasic REM activity) and completed the Beck Depression Inventory
(BDI) and RBD Screening Questionnaire (RBDSQ). Patients were classified
into diagnostic categories: yes-RBD (n=22; EMGscore≥10% plus
RBDSQ≥5 or observed-RBD), no-RBD (n=16; EMGscore