Visual hallucinations as REM sleep behavior disorders in patients with Parkinson's disease.
To clarify whether visual hallucinations in patients with Parkinson's disease (PD) are related to rapid eye movement (REM) sleep, nocturnal polysomnographic variables were compared between a group with hallucinations (hallucinators, n = 14) and a group without hallucinations (nonhallucinators, n = 8). A multiple sleep latency test (MSLT) was performed on 3 hallucinators, and the content of dreams during daytime REM sleep was investigated. The efficacy of clonazepam, a standard treatment choice for REM sleep behavior disorders, was investigated in 8 hallucinators. Nocturnal polysomnograms of the hallucinators showed a higher amount of stage 1-REM sleep with tonic electromyogram (stage 1-REM) than the nonhallucinators, and the reported occurrences of nocturnal hallucinations corresponded with the periods of stage REM or stage 1-REM in most hallucinators. The frequency of sleep onset REM periods (SOREMP) on the MSLT were pathologically high in the hallucinators, and the content of the dreams during the MSLT period was quite similar to their hallucinations. During clonazepam treatment, the frequency of hallucinatory symptoms decreased in 5 of 8 hallucinators. These results indicate that visual hallucinations in PD are likely to be related to a REM sleep disorder manifested as the appearance of both stage 1-REM during the night and SOREMP in the daytime.
Nomura
Takashi
T
Department of Neurology, Institute of Neurological Sciences, Tottori University Faculty of Medicine, Yonago, Japan. ZVS03523@nifty.ne.jp
Inoue
Yuichi
Y
Mitani
Hidetaka
H
Kawahara
Ryuzo
R
Miyake
Masahiro
M
Nakashima
Kenji
K
D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000187:drug effects / Q000503:physiopathology; D002940:Circadian Rhythm / Q000187:drug effects; D002986:Clinical Trials as Topic; D002998:Clonazepam / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004325:Dreams / Q000187:drug effects / Q000502:physiology; D004359:Drug Therapy, Combination; D005260:Female; D006212:Hallucinations / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011930:Reaction Time / Q000187:drug effects / Q000502:physiology; D012895:Sleep, REM / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
D000927:Anticonvulsants; D000978:Antiparkinson Agents; D002998:Clonazepam