REM sleep behavior disorder and narcoleptic features in anti-Ma2-associated encephalitis.
A 69-year-old man with anti-Ma2 paraneoplastic encephalitis presented with subacute onset of severe hypersomnia, memory loss, parkinsonism, and gaze palsy. A brain magnetic resonance imaging study showed bilateral damage in the dorsolateral midbrain, amygdala, and paramedian thalami. Videopolysomnography disclosed rapid eye movement (REM) sleep behavior disorder, and a Multiple Sleep Latency Test showed a mean sleep latency of 7 minutes and 4 sleep-onset REM periods. The level of hypocretin-1 in the cerebrospinal fluid was low (49 pg/mL). This observation illustrates that REM sleep behavior disorder and narcoleptic features are 2 REM-sleep abnormalities that (1) may share the same autoimmune-mediated origin affecting the brainstem, limbic, and diencephalic structures and (2) may occur in the setting of the paraneoplastic anti-Ma2-associated encephalitis.
Compta
Yaroslau
Y
Neurology Service, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Iranzo
Alex
A
Santamaría
Joan
J
Casamitjana
Roser
R
Graus
Francesc
F
D000368:Aged; D000951:Antigens, Neoplasm / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D001921:Brain / Q000276:immunology* / Q000473:pathology*; D004660:Encephalitis / Q000150:complications* / Q000276:immunology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009290:Narcolepsy / Q000150:complications*; D009419:Nerve Tissue Proteins / Q000276:immunology*; D020187:REM Sleep Behavior Disorder / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*
D000951:Antigens, Neoplasm; D001323:Autoantibodies; C119249:Ma2 antigen; D009419:Nerve Tissue Proteins