Hideki Sakuta

Probable rapid eye movement sleep behavior disorder, nocturnal disturbances and quality of life in patients with Parkinson's disease: a case-controlled study using the rapid eye movement sleep behavior disorder screening questionnaire

BackgroundIncreasing evidence provides a clear association between rapid eye movement sleep behavior disorders (RBD) and Parkinson’s disease (PD), but the clinical features that determine the co-morbidity of RBD and PD are not yet fully understood.MethodsWe evaluated the characteristics of nocturnal disturbances and other motor and non-motor features related to RBD in patients with PD and the impact of RBD on their quality of life. Probable RBD (pRBD) was evaluated using the Japanese version of the RBD screening questionnaire (RBDSQ-J).ResultsA significantly higher frequency of pRBD was observed in PD patients than in the controls (RBDSQ-J ≥ 5 or ≥ 6: 29.0% vs. 8.6%; 17.2% vs. 2.2%, respectively). After excluding restless legs syndrome and snorers in the PD patients, the pRBD group (RBDSQ-J≥5) showed higher scores compared with the non-pRBD group on the Parkinson’s disease sleep scale-2 (PDSS-2) total and three-domain scores. Early morning dystonia was more frequent in the pRBD group. The Parkinson’s Disease Questionnaire (PDQ-39) domain scores for cognition and emotional well-being were higher in the patients with pRBD than in the patients without pRBD. There were no differences between these two groups with respect to the clinical subtype, disease severity or motor function. When using a cut-off of RBDSQ-J = 6, a similar trend was observed for the PDSS-2 and PDQ-39 scores. Patients with PD and pRBD had frequent sleep onset insomnia, distressing dreams and hallucinations. The stepwise linear regression analysis showed that the PDSS-2 domain “motor symptoms at night”, particularly the PDSS sub-item 6 “distressing dreams”, was the only predictor of RBDSQ-J in PD.ConclusionOur results indicate a significant impact of RBD co-morbidity on night-time disturbances and quality of life in PD, particularly on cognition and emotional well-being. RBDSQ may be a useful tool for not only screening RBD in PD patients but also predicting diffuse and complex clinical PD phenotypes associated with RBD, cognitive impairment and hallucinations.

Evaluation of cutoff scores for the Parkinson's disease sleep scale-2

The Parkinsons Disease Sleep Scale (PDSS)‐2 is a recently developed tool for evaluating disease‐related nocturnal disturbances in patients with Parkinsons disease (PD). However, its cutoff score has not been clinically assessed. We determined the optimal cutoff score of the Japanese version of the PDSS‐2.

Serum uric acid levels in Parkinson's disease and related disorders

Serum uric acid (UA) levels are reported to be decreased in patients with Parkinsons disease (PD) and multiple system atrophy (MSA). However, clinical correlates of serum UA levels are still unclear in PD‐related disorders. We conducted a cross‐sectional study to evaluate the associations between serum UA levels and disease duration, disease severity, and motor function among PD, MSA, and progressive supranuclear palsy (PSP) patients.

Sleep Disturbances in Patients with Parkinson’s Disease

Sleep disturbances are among the most common disabling nonmotor symptoms of Parkinson disease (PD). Recently, awareness of sleep disorders related to PD has increased, reflecting their significant negative impact on the quality of life of the patient. However, sleep disturbances are still often under-recognized. In PD, multiple factors are associated with sleep disturbances; impaired arousal systems and sleep structure as disease-related changes, nocturnal motor symptoms, hallucinations and psychosis, pain, nocturia, depressive symptoms and dopaminergic medication can all cause insomnia. Further, these factors can coexist and influence each other during the course of the disease. In addition, sleep-related breathing disorder, restless legs syndrome (RLS) and rapid eye movement sleep behavior disorder (RBD) can also lead to impaired sleep. Some idiopathic RBD patients have been associated with a risk for developing neurodegenerative diseases, including PD. Therefore, early diagnosis of RBD may have significant clinical implications for neuroprotective strategies. Several studies have revealed an increased incidence of RLS in PD patients compared to the general population. The favorable responses to dopaminergic medications in treating both RLS and PD suggest shared pathophysiologies between the two diseases; however, neuroimaging studies of dopaminergic systems remain inconclusive. In this review, we discuss the current understanding of sleep disturbances in PD and the existing treatments.

Successful Laparoscopic Resection of 7 mm Ovarian Mature Cystic Teratoma Associated with Anti-NMDAR Encephalitis

Anti-NMDAR (N-methyl-D-aspartate receptor) encephalitis is an immune-mediated encephalitis. It has been predominantly described in young women and is commonly associated with an ovarian teratoma. We report a case of anti-NMDAR encephalitis associated with a 7 mm ovarian teratoma that was completely resected by laparoscopic surgery. An 18-year-old woman suddenly presented with personality changes requiring her admission to the department of neurology. After that, she also showed involuntary movements, disturbance of consciousness, and central hypoventilation. As an abdominal image revealed the possibility of a right ovarian teratoma of 5 × 7 mm, a laparoscopic operation was performed. The macroscopic appearance of the right ovary did not show any abnormalities; nevertheless, we performed a partial resection of the right ovary, with reference to the image diagnosis, in order to spare the ovarian reserve. The 22 × 22 mm partially resected ovary contained an intact 5 × 7 mm cystic tumor. The pathological diagnosis was mature cystic teratoma with components of brain tissue. An anti-NMDAR-antibody test proved positive in both serum and cerebrospinal fluid 1 month after the surgery. From these results, she was diagnosed with anti-NMDAR encephalitis. By the administration of cyclophosphamide in addition to the operation, she recovered drastically without any of the symptoms shown before.

Computer mouse-related dystonia: a novel presentation of task-specific dystonia

Task-specific dystonia (TSD) is a disabling movement disorder characterized by focal, involuntary, and excessive muscle contractions that develop in a single body part involved in highly skilled tasks [1]. In TSD, involvement of the hand (while writing, typing, or playing a musical instrument) is more common than the involvement of other parts of the body, but TSD related to the use of a computer mouse has never been described. A 68-year-old right-handed man presented to our outpatient clinic with involuntary flexion of his right thumb, which interfered with the use of a computer mouse. When the patient was 62 years old, he started composing music using a computer. Since then, he had used the computer mouse with his right hand for composition for approximately 5 h per day. At age 64, he developed abnormal flexion of his right thumb whenever he used the computer mouse; the flexion interfered with moving the mouse, but he could click the mouse button without any trouble. During the following year, abnormal flexion in the right thumb was observed even when the patient put his right hand on the table, and he had difficulty in extending and flexing his right thumb voluntarily. This forced him to use the computer mouse with his left hand instead. He had no symptoms in other parts of the body. The patient had played classical guitar since childhood. He had no previous medical history of psychiatric disease or a family history of dystonia. The patient had no history of alcohol use or smoking. The initial examination showed excessive flexion of his right thumb, and voluntary flexion and extension of his right thumb was impaired. This abnormal posture significantly worsened when using the computer mouse (see video, segment 1). However, he noticed that right-thumb flexion never occurred while eating (using chopsticks, spoon, or knife) or writing with a pen. The abnormal flexion of his right thumb never occurred when his right thumb and index finger touched. A neurological examination was unremarkable except for the abnormal flexion position of his right thumb. Laboratory data were normal. The finding of brain magnetic resonance images was normal. TSD was diagnosed based on the observation that involuntary and excessive flexion posture was prominent in specific situations. Oral medications such as levodopa, carbamazepine, and phenytoin were ineffective. The patient was then treated with clonazepam 0.5 mg, which modestly improved his symptoms. The combined use of clonazepam 1 mg and trihexyphenidyl 6 mg resulted in significant improvement of his symptoms (see video, segment 2). We report the first case of a patient in whom excessive flexion of the right thumb occurred initially only when using the computer mouse. Similar to other TSD patients [1], our patient’s symptoms later involved other tasks. As the patient had dystonic posturing of the right hand at rest at the examination, the patient was classified as having complex TSD rather than simple TSD [2]. His finger movements were preserved when his right thumb and index Electronic supplementary material The online version of this article (doi:10.1007/s00415-012-6519-1) contains supplementary material, which is available to authorized users.