Tuesday, April 7, 2015

Study group discussion: REM Sleep Behavior Disorder and Parkinson's disease

I just studied that fatal familial insomnia is a prion disease.

We had a discussion on fatal familial insomnia before!

Fatal familial insomnia, harmful effects of working at night and sleeping during the day  http://medicowesome.blogspot.com/2015/02/study-group-discussion-fatal-familial.html

Oh, I shall have a look over that discussion!

So basically it's thalamus that is missing :)

What is the centre for REM sleep in particular that is affected in idiopathic Parkinson's? I can't remember that center! It's important because in idiopathic Parkinson's disease, earliest symptom REM sleep behavior disorder.

Umm.. I can't remember that! Is it the one which regulates the circadian rhythm?

I found an interesting read on Parkinson's, rem in Harrison. I'll post it here!

REM Sleep Behavior Disorder RBD is a rare condition that is distinct from other parasomnias in that it occurs during REM sleep. It primarily afflicts men of middle age or older, many of whom have a history of prior neurologic disease.

Infact, over one-third of patients will go on to develop Parkinson's disease within 10 to 20 years.

Presenting symptoms consist of agitated or violent behavior during sleep, reported by a bedpartner. In contrast to typical somnambulism, injury to patient or bed partner is not uncommon, and, upon awakening, the patient reports vivid, often unpleasant, dream imagery.

The principal differential diagnosis is that of nocturnal seizures, which can be excluded with polysomnography. In RBD, seizure activity is absent on the EEG, and disinhibition of the usual motor atonia is observed in the EMG during REM sleep, at times associated with complex motor behaviors.

The Pathogenesis is unclear, but damage to brainstem areas mediating descending motor inhibition during REM sleep may be responsible. In support of this hypothesis are the remarkable similarities between RBD and the sleep of animals with bilateral lesions of the pontine tegmentum in areas controlling REM sleep motor inhibition.

Treatment with clonazepam (0.5 to 1.0 mgqhs) provides sustained improvement in almost all reported cases.

So it's the brainstem! :D


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