title: Depression as the Primary Cause of Insomnia and Excessive Daytime Sleepiness in a Family with Multiple Cases of Spinocerebellar Ataxia.
abstract: Spinocerebellar ataxia (SCA) is a hereditary disease characterized by central nervous system-related motor dysfunctions. Sleep disorders and frequent non-motor manifestations are commonly comorbid with SCA. To elucidate this relationship, we present three cases in a family that included multiple SCA type 2 patients with various sleep disorders. Complete physical examination, and genetic and imaging studies were performed. Anti-parkinsonism medications were prescribed after neurological examination. Clonazepam and/or quetiapine were administered for sleep disorders but failed to resolve insomnia and excessive daytime sleepiness (EDS). Based on DSM-5 criteria, all cases were diagnosed with depression. After treatment with serotonin-norepinephrine reuptake inhibitors and noradrenergic and specific serotonergic antidepressants, symptoms of insomnia and EDS, which are strongly associated with depression in SCA type 2 patients, improved significantly. It is crucial to recognize insomnia and EDS in neurodegenerative diseases, not only for earlier diagnosis, but also to improve quality of life.
authors.affiliation: Department of Family Medicine, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Chun-Hsien
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Department of Pathology, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Dee
authors.initials: D
authors.lastname: Pei
authors.affiliation: Department of Family Medicine, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Shu-Man
authors.initials: SM
authors.lastname: Yu
authors.affiliation: Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.|Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: I-Chao
authors.initials: IC
authors.lastname: Liu
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy; D006970:Disorders of Excessive Somnolence / Q000150:complications* / Q000188:drug therapy; D005190:Family; D005260:Female; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069348:Quetiapine Fumarate / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000188:drug therapy; D020754:Spinocerebellar Ataxias / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002998:Clonazepam; D018757:GABA Modulators; D000069348:Quetiapine Fumarate; D017367:Selective Serotonin Reuptake Inhibitors
keywords: depression; excessive daytime sleepiness; insomnia; sleep disorders; spinocerebellar ataxia