title: Quetiapine improves visual hallucinations in Parkinson disease but not through normalization of sleep architecture: results from a double-blind clinical-polysomnography study.
abstract: Polysomnographic studies of Parkinson's disease (PD) patients with visual hallucinations (VH) usually reveal short, fragmented rapid eye movement (REM) sleep, with lower sleep efficiency and reduced total REM sleep. Quetiapine has been demonstrated in open-label trials to be effective for the treatment of insomnia and VH in PD. To confirm quetiapine's efficacy in improving VH, and to determine whether the mechanism was due to its effect on REM sleep architecture, we performed a pilot, double-blind, placebo-controlled study. Sixteen PD patients experiencing VH were recruited. Eight patients were randomized to quetiapine and eight patients to placebo. Patients underwent pre- and post-treatment polysomnography. The Clinical Global Impression Scale (CGIS), Brief Psychiatric Rating Scale (BPRS), and Unified Parkinson Disease Rating Scale (UPDRS) motor subscale were obtained. There were no differences in baseline characteristics between the treatment arms except that the placebo group had more sleep in stage REM (74.7 min vs. 40.1 min; p < .001). Data were imputed for all patients who prematurely discontinued (four quetiapine and one placebo) in an intention-to-treat analysis. The average quetiapine dose was 58.3 mg/day. While there was no significant difference in the change in REM duration pre- vs. post-treatment in either arm, patients randomized to quetiapine improved on the CGIS (p = .03) and the hallucination item of the BPRS (p = .02). No difference was noted in the UPDRS motor scores. Despite the small sample, this is the first double-blind trial to show quetiapine's efficacy over placebo in controlling VH in the PD population. However, normalization of sleep architecture was not supported as the mechanism.
authors.affiliation: Department of Neurology, College of Medicine, University of Florida, FL, USA. Fernandez@neurology.ufl.edu
authors.forename: Hubert H
authors.initials: HH
authors.lastname: Fernandez
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Rodriguez
authors.forename: Irene A
authors.initials: IA
authors.lastname: Malaty
authors.forename: Janet
authors.initials: J
authors.lastname: Romrell
authors.forename: Anqi
authors.initials: A
authors.lastname: Sun
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.forename: Sandeep
authors.initials: S
authors.lastname: Pillarisetty
authors.forename: Anand
authors.initials: A
authors.lastname: Nyathappa
authors.forename: Stephan
authors.initials: S
authors.lastname: Eisenschenk
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006212:Hallucinations / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D010865:Pilot Projects; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D000069348:Quetiapine Fumarate; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects*; D012895:Sleep, REM / Q000187:drug effects; D016896:Treatment Outcome; D014796:Visual Perception / Q000187:drug effects*
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate