REM Sleep Behavior Disorder and Epileptic Phenomena: Clinical Aspects of the Comorbidity

Summary:  Purpose: To document the occurrence of REM sleep behavior disorder (RBD) episodes in patients with epilepsy, and of interictal EEG epileptiform abnormalities (IEA) in patients with idiopathic RBD.
Methods: Consecutive observations in a tertiary epilepsy center and a tertiary sleep center. RBD diagnosis was based on standard clinical and video-polysomnographic findings.
Results: Co-occurrence of epileptic seizures and RBD episodes was found in six cases (all men; mean age 70.5 ± 11.1 years). Focal, isolated, sporadic sharp waves during wakefulness and/or during sleep were documented in 9 out of 34 (26.4%) patients with idiopathic RBD; no significant differences in age at onset and duration of RBD emerged between RBD patients with and without IEA.
Conclusions: RBD episodes can occur in epilepsy patients and focal IEA in patients with idiopathic RBD. This, apart from being a possible cause for misdiagnosis, may indicate a possible link between the two disorders. Further systematic investigations of the occurrence of RBD episodes in epilepsy will help to establish the real extent of this comorbidity and its ultimate neurobiological significance.     

REM Sleep Behavior Disorder and REM Sleep Without Atonia as an Early Manifestation of Degenerative Neurological Disease

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by repeated episodes of dream enactment behavior and REM sleep without atonia (RSWA) during polysomnography recording. RSWA is characterized by increased phasic or tonic muscle activity seen on polysomnographic electromyogram channels. RSWA is a requisite diagnostic feature of RBD, but may also be seen in patients without clinical symptoms or signs of dream enactment as an incidental finding in neurologically normal individuals, especially in patients receiving antidepressant therapy. RBD may be idiopathic or symptomatic. Patients with idiopathic RBD often later develop other neurological features including parkinsonism, orthostatic hypotension, anosmia, or cognitive impairment. RSWA without clinical symptoms as well as clinically overt RBD also often occurs concomitantly with the α-synucleinopathy family of neurodegenerative disorders, which includes idiopathic Parkinson disease, Lewy body dementia, and multiple system atrophy. This review article considers the epidemiology of RBD, clinical and polysomnographic diagnostic standards for both RBD and RSWA, previously reported associations of RSWA and RBD with neurodegenerative disorders and other potential causes, the pathophysiology of which brain structures and networks mediate dysregulation of REM sleep muscle atonia, and considerations for the effective and safe management of RBD.     

Clinical Considerations of Obstructive Sleep Apnea with Little REM Sleep

MethodsPatients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep <20% of total sleep time (TST)], normal REM sleep (20–25% of TST), and excessive REM sleep (>25% of TST). Multiple logistic regression analyses were applied to the data. The success rate of continuous positive airway pressure (CPAP) titration was estimated in these groups.ResultsThe age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m², respectively. The 902 patients comprised 684 (76%) men and 218 (24%) women. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple logistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence interval, 1.020–1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038).ConclusionsThe AHI is higher and the success rate of CPAP titration is lower in OSA patients with little REM sleep than those with normal REM sleep.     

血管源性帕金森综合征抑郁、焦虑与其他症状的关系研究

目的 研究血管源性帕金森综合征（vascular parkinsonism,VP）患者焦虑、抑郁的发病率以及焦虑、抑郁与运动症状、非运动症状的关系。      

帕金森病非运动症状研究进展

帕金森病(PD)是好发于中老年的神经系统变性疾病,PD不仅表现出核心的运动症状(MS),还表现出各种的非运动症状(NMS),NMS是PD发生频率很高且非常重要的症状,可以出现在PD的任何阶段。NMS能促进PD的早期诊断,也是引起PD患者日常生活能力及生命质量降低的重要原因。文中从感觉障碍、神经精神障碍、自主神经功能障碍、睡眠障碍、疲劳等方面对PD患者的NMS相关研究进展进行综述。     

Current Concepts and Controversies in the Management of REM Sleep Behavior Disorder

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment and the loss of muscle atonia during REM sleep, known as REM sleep without atonia (RSWA). RBD can result in significant injuries, prompting patients to seek medical attention. However, in others, it may present only as non-violent behaviors noted as an incidental finding during polysomnography (PSG). RBD typically occurs in the context of synuclein-based neurodegenerative disorders but can also be seen accompanying brain lesions and be exacerbated by medications, particularly antidepressants. There is also an increasing appreciation regarding isolated or idiopathic RBD (iRBD). Symptomatic treatment of RBD is a priority to prevent injurious complications, with usual choices being melatonin or clonazepam. The discovery that iRBD represents a prodromal stage of incurable synucleinopathies has galvanized the research community into delineating the pathophysiology of RBD and defining biomarkers of neurodegeneration that will facilitate future disease-modifying trials in iRBD. Despite many advances, there has been no progress in available symptomatic or neuroprotective therapies for RBD, with recent negative trials highlighting several challenges that need to be addressed to prepare for definitive therapeutic trials for patients with this disorder. These challenges relate to i) the diagnostic and screening strategies applied to RBD, ii) the limited evidence base for symptomatic therapies, (iii) the existence of possible subtypes of RBD, (iv) the relevance of triggering medications, (v) the absence of objective markers of severity, (vi) the optimal design of disease-modifying trials, and vii) the implications around disclosing the risk of future neurodegeneration in otherwise healthy individuals. Here, we review the current concepts in the therapeutics of RBD as it relates to the above challenges and identify pertinent research questions to be addressed by future work.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-020-00983-7.Key Words: REM sleep behavior disorder, disease-modifying, treatment, neurodegeneration, sleep     

卒中相关非运动症状多学科管理专家共识

<正>随着脑血管病治疗手段的精进,中国卒中患者的死亡率不断下降,越来越多的卒中患者得以长期生存。卒中相关非运动症状给长期生存的卒中患者带来很多困扰,严重影响患者的预后和生活质量。卒中相关非运动症状需要多学科团队共同参与管理。北京脑血管病防治协会成立《卒中相关非运动症状多学科管理专家共识》（以下简称《共识》）编写委员会,组织多学科专家编写《共识》,形成对卒中相关非运动症状临床诊疗和管理的建议,以期更加规范地服务于卒中患者。     

Perceived Emotional Intelligence and Clinical Symptoms in Mental Disorders

Research in emotional regulation has revealed that difficulties in the use and processing of affective information constitute a key factor in most mental disorders. To evaluate perceived emotional intelligence (PEI) deficits in patients with diverse psychopathological disorders and their relationship with clinical symptoms. Differences in PEI have been identified between a clinical group (n?=?163) and a group of non-clinical individuals (n?=?163). In the clinical group, the patients met DSM diagnostic criteria for one of the following: anxiety disorder, mood disorder, substance abuse disorder, psychotic disorder or borderline personality disorder. The PEI and clinical symptoms were assessed using the Spanish version of the TMMS-24 and the SCL-90-R, respectively. Patients from clinical group show higher levels of attention to feelings, but lower scores in abilities to manage effectively their negative emotional states compared to participants from non-clinical control group. Similarly, significant differences in PEI levels between different diagnostic groups were found. Our study provides preliminary evidence that deficits in PEI are related to the presence and severity of clinical symptoms in patients with different mental disorders.     

帕金森病非运动症状波动的临床研究进展

帕金森病患者通常伴随多种非运动症状,随病程进展,大部分非运动症状可以呈现类似运动波动的变化,称之为非运动症状波动。非运动症状波动发生频率较高,是影响帕金森病患者生活质量的重要原因,临床诊治过程中应受到重视。文中从流行病学特点和临床表现、危险因素、发生机制、临床干预等方面对帕金森病非运动症状波动相关研究进行综述。