Sleepwalking in patients with Parkinson disease.
OBJECTIVE
To report the occurrence of adult-onset (de novo) sleepwalking in a series of 6 patients with idiopathic Parkinson disease (PD).


METHODS
Case series.


METHODS
Outpatient clinic for movement disorders.


METHODS
Of 165 consecutive patients with PD seen for 2 years, 6 patients with adult-onset sleepwalking were identified. These patients underwent a systematic clinical assessment of their extrapyramidal and sleep problems, which included standard questionnaires, clinical examination, and estimation of PD severity (motor score of the Unified PD Rating Scale and Hoehn and Yahr stage). Five of 6 patients had a video-polysomnography recording that was scored according to international criteria.


RESULTS
Patients included 3 women and 3 men with a mean (+/-SD) age of 66 +/- 12 years (range, 46-78 years). The mean (+/-SD) Unified PD Rating Scale score was 25 +/- 9 (range, 10-35) and the mean (+/-SD) Hoehn and Yahr stage was 2.5 +/- 1.0 (range, 1.0-4.0). Medications in these patients included levodopa (n = 6), dopamine agonists (n = 4), selective serotonin reuptake inhibitor antidepressants (n = 3), and hypnotics (n = 3). All patients had at least 1 concomitant sleep-wake disorder, including rapid eye movement sleep behavior disorder (n = 4) and insomnia (n = 4). In 2 of 6 patients, the latency between onset of PD and appearance of sleepwalking was more than 4 years.


CONCLUSIONS
Neurodegenerative changes associated with PD at the brainstem level can affect the "ascending" control of state transition (leading to dissociated arousals from non-rapid eye movement and/or rapid eye movement sleep) and the "descending" control of locomotion and muscle tone, together giving rise to various sleep-associated behavioral disturbances including sleepwalking, rapid eye movement sleep behavior disorder, and overlap parasomnia.
Poryazova
Rositsa
R
Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland.
Waldvogel
Daniel
D
Bassetti
Claudio L
CL
D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D004325:Dreams / Q000523:psychology; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology; D017286:Polysomnography; D012893:Sleep Wake Disorders / Q000150:complications; D013009:Somnambulism / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose