دانلود رایگان مقاله انگلیسی اختلالات نوروژنیک و خواب - الزویر 2018

Parasomnias

Patients with PD may complain of abnormal movements during sleep. This may be from a variety of conditions including sleep myoclonus, periodic limb movements of sleep, tremor, dystonia, or parasomnias. RBD is the most common parasomnia seen in patients with PD, seen in up to 60% of patients with PD. RBD is even more common in multiple-system atrophy and Lewy body dementia (75% or higher).23 RBD involves repeated episodes of sleep-related vocalization and/or complex motor behaviors that occur during REM sleep. Motor activity can be reaching, grabbing, kicking, or other vigorous motor activity that could lead to injury of the patient or bed partner.4 Nonviolent behaviors, such as smiling, laughing, or shouting, can also occur. The patient does not typically ambulate, with almost all motor activity occurring in or next to the bed. Eyes are typically closed and the patient does not interact with the environment. If awoken from the event, the patient returns to normal levels of consciousness, but may remember dream content related to the motor activity. Patients with PD with RBD have fewer tremors, more falls, more autonomic dysfunction, and more cognitive dysfunction than patients with PD who do not have RBD.24 RBD has been shown to be a prodromal stage for PD and other synucleinopathies. Studies following patients with idiopathic RBD have demonstrated high rates of conversion to PD and other synucleinopathies, with a 45% rate of conversion at 5 years, 76% rate at 10 years, and more than 90% rate at 14 years.25 These patients with RBD at high risk for central nervous degenerative disorders will likely be ideal candidates for neuroprotective therapy when they become available, although at this time no proven therapies of this kind exist. Patients with idiopathic RBD need to be counseled in regards to this risk and followed for early signs of cerebral neurodegenerative conditions, namely synucleinopathies. This follow-up may include questioning in regards to symptoms; serial neurologic examinations to look for early signs of disease; or more formal testing, such as neuropsychological testing or imaging of the brain.