P-PPMI NY may RBD

Transcription

1 P-PPMI NY may RBD G. Mayer, M. Bitterlich, C. Doerr Schwalmstadt, Marburg University W. Oertel, Marburg University K. Kesper, Marburg University G. Antony, Parkinson Kompetenznetz KNP, Marburg

2 Classification ICSD 2 A. Violent or injurious behavior in sleep B. Limb- or body movements that relate to dream contents behavior: - Aggressive sleep behavior - Acting out dream contents - Fragmentation of sleep continuity C.Polysomnography - Excessive increase of chin EMG - Excessive chin EMG or limb movement - Complex, aggressive behavior D. Symptoms must not be caused by psychiatric disorders, association with neurological disorders (no epilepsies!) E. Other sleep disorders may be present but are not the cause

3 AASM criteria 2012 ICCN Berlin 2014

4 Disease progression R control L De novo olfactory dysfunction 2 years 7,5 years obstipation RBD depression years Disease progression (modified from Schwarz et al., 2004)

5 RBD and neurodegeneration irbd: conversion into neurodegenerative disease years Braak model of neurodegeneration Olfactory dysfunction in PD 100% Iranzo 2013 irbd 29 pts. 5 y Impaired olfaction (60%) increases PD risk 5.2 fold (Ross 2008) 10 y 38% 80%

6 RBD criteria ICSD2 and AASM 2007 Both PSG and videoanalysis required Minimal duration of REM sleep: 5 min PSG (according to Frauscher 2012): Cut off (3 s bins): Any EMG activity in mentalis 18% Any EMG activity mentalis+fds 32% - Cut off (30 s bins): Any EMG activity in mentalis 27% Video RBDSS: proposed cut-off: 2/1 Any EMG activity in mentalis+fds 32% 0 = no visible movement; 1 = slight movements or jerks 2 = movements involving proximal extremities, including violent behavior; 3 = axial involvement including bed falls. Vocalizations were rated as 1 for present or 0

7 New since % REM sleep

8 What we see Please look at comments

9 no patients P-PPMI Problems recruiting: depending on decisions of ECs 35 no patients/center C 307 C 291 C 290 C 120 C 088 C 057 C 032 C 18 C040 Centers

10 PSG: SINBAR scoring Phasic muscle activity is higlighted in the chin (red), and tonic muscle activity in the chin and extremities (blue).

11 % REM % RWA % RWA Analysis each center RWA/Center, any EMG (3 sec) RWA/Center, any EMG (30 sec) C 307 C 291 C 290 C 120 C 088 C 057 C 032 C 018 C040 0 C 307 C 291 C 290 C 120 C 088 C 057 C 032 C 018 C040 Centers Centers % REM/Center C 307 C 291 C 290 C 120 C 088 C 057 C 032 C 018 Centers C040

12 % RWA EMG analysis all centers 69 PSGs, 13 excluded 60 EMG analysis phas. EMG (3s.) any EMG (3s.) ton. EMG (30s.) phas. EMG (30s.) any EMG (30s.) REM% RWA scoring method

13 How to improve? Optimise quality of PSGs Recruit more patients until end of 2014 Include patients with clinical RBD who do not meet PSG criteria Who do not meet DAT scan criteria this requires repeat PSG QC requires repeated measurement

14 REM sleep atonia index 1-sec mini-epochs average amplitude of rectified mentalis EMG signal for each mini-epoch EMG atonia amplitude 1 V,activation > 2 V ICCN Berlin 2014

15 REM sleep and movement throughout the life span Ferri et al ICCN Berlin 2014

16 Variability of muscle activity in REM sleep during 6 consecutive nights 12 irbd, 8 controls Any muscle activity/30 sec (Frauscher 2013) ICCN Berlin 2014

17 ICCN Berlin 2014

18 Videometric analysis RBDSS Sixel-Döring et al., j Clin sleep med 2011 Motor Events 0. = no visible motor activity, RWA present 1. = small movements or jerks 2. = proximal movements including violent behavior 3. = axial movements including bed falls 73 RBD episodes in 20 PD pats. Vocalizations 0. = no vocalization 1. = all sleep associated sounds other than respiratory noises ICCN Berlin 2014

19 RBD and 123I-fp-cit-spect iranzo et al In 40% of irbd Pathological in 75% of RBD pts with conversion ICCN Berlin 2014

20 Biomarkers RBD Strong markers Typical symptoms RSWA Olfactory deficits Cardial MIBG deficits DAT scan? PDRP? Weak markers Transcranial ultrasound MCI EEG slowing Sensitivity and specificity of most biomarkers depends on time of RBD diagnosis ICCN Berlin 2014

21 Videometric analysis RBDSS Sixel-Döring et al., j Clin sleep med 2011 Motor Events 0. = no visible motor activity, RWA present 1. = small movements or jerks 2. = proximal movements including violent behavior 3. = axial movements including bed falls 73 RBD episodes in 20 PD pats. Vocalizations 0. = no vocalization 1. = all sleep associated sounds other than respiratory noises ICCN Berlin 2014

22 Significance of dream recall in RBD Valli et al., JSR 2012 A link between motor behavior and dreams? PD+RBD patients Awakenings 10 min after REM onset Expert evaluation Correctly identified video related dreams 39.5% ICCN Berlin 2014