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Dr. Okun

Post of the Week: DBS and Sleep

7 posts in this topic

Dear forum members,

 

Recently there has been an expanding amount of data suggesting improvements in sleep quality following DBS. Here is another small paper that is notable, as they used pre- and post-operative sleep studies.

 

 

Mov Disord. 2011 Nov;26(13):2418-22. doi: 10.1002/mds.23862. Epub 2011 Jul 7.

Subthalamic nucleus deep brain stimulation restores normal rapid eye movement sleep in Parkinson's disease.

Nishida N, Murakami T, Kadoh K, Tohge R, Yamanegi M, Saiki H, Ueda K, Matsumoto S, Ishikawa M, Takahashi JA, Toda H.

Source

Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan; Department of Molecular Behavioral Biology, Osaka Bioscience Institute, Suita, Osaka, Japan.

Abstract

BACKGROUND:

In Parkinson's disease, sleep disturbance is a common occurrence.

 

METHODS:

We evaluated sleep in 10 patients with Parkinson's disease (age, 57.5 ± 9.8 years; disease duration, 12.3 ± 2.7 years) before and after subthalamic nucleus deep brain stimulation using the Parkinson's disease sleep scale and polysomnography.

 

RESULTS:

Their total sleep scale scores and daytime sleepiness subscale scores significantly improved after subthalamic nucleus-deep brain stimulation. The novel findings from this study significantly increased normal rapid eye movement sleep, and decreased abnormal rapid eye movement sleep without atonia after deep brain stimulation in patients with Parkinson's disease. The improved total sleep scale score correlated with decreased wakefulness after sleep onset. Moreover, improved daytime sleepiness correlated with increased normal rapid eye movement sleep time. Sleep improvement did not significantly correlate with resolution of motor complication or reduced dopaminergic dosages.

 

CONCLUSIONS:

Subthalamic nucleus-deep brain stimulation may have beneficial effects on sleep disturbance in advanced Parkinson's disease by restoring sleep architecture and normal rapid eye movement sleep. © 2011 Movement Disorder Society.

 

Copyright © 2011 Movement Disorder Society.

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Since only 10 patients were studied, I perssonally have serious doubts re: the validity of the findings. True, PD is different in all of us, but there are more than 10 of us! I have had bilateral DBS/STN surgeries, seven years apart. The first in 2003 for my left side symptoms, and again in 2010 for my right side.

 

While most PWP were complaining about their respective sleep problems, I had none, after living with PD for about 25 years back then. In 2003 that all changed after my first DBS/STN. Shortly after being "turned on" in Apr., 2003 my problems with my

 

REM sleep patterns beginning to change. At first, my nighttime story telling would awaken my wife. Then my legs, then my arms and fists, etc. To make a long story short, after my 2nd DBS/STN i June, 2010, my wife and I no longer sleep in the same room together. My suggestion, for her safety! My REM Sleep Behavior problem worsened ten-fold!

I began taking .5MG of generic Klonopin (clonazepam). That worked for a while, but didn't stop it completely. Now-a-days I take 1MG, sometimes 2MG before bedtime. The last feew "episodes" have really scared me! For some stramge reason I've been jumping off of my bed, head first t4ying to "catch the shadow person" who keeps trying to wake me up!

 

Fortunately, I have managed, somehow, to not "land" on either of my two scull "plugs" where the leads go into my brain. I am sore and bruised, and just like my PD, which I've had now for 35 yrs, I see no end to my REM sleep behavioral disorder. They both progress, on and on and on, worseand worse and worse!

 

It bothers me tremendously not to be able to share the same bedroom with my wife, but her safety and welfare are more important to me!

 

Regards,

 

Jim Evridge "AKA:SILVERFOXX_FIGHTING_BACK" STILL!!!!!

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Since only 10 patients were studied, I perssonally have serious doubts re: the validity of the findings. True, PD is different in all of us, but there are more than 10 of us! I have had bilateral DBS/STN surgeries, seven years apart. The first in 2003 for my left side symptoms, and again in 2010 for my right side.

 

While most PWP were complaining about their respective sleep problems, I had none, after living with PD for about 25 years back then. In 2003 that all changed after my first DBS/STN. Shortly after being "turned on" in Apr., 2003 my problems with my

 

REM sleep patterns beginning to change. At first, my nighttime story telling would awaken my wife. Then my legs, then my arms and fists, etc. To make a long story short, after my 2nd DBS/STN i June, 2010, my wife and I no longer sleep in the same room together. My suggestion, for her safety! My REM Sleep Behavior problem worsened ten-fold!

I began taking .5MG of generic Klonopin (clonazepam). That worked for a while, but didn't stop it completely. Now-a-days I take 1MG, sometimes 2MG before bedtime. The last feew "episodes" have really scared me! For some stramge reason I've been jumping off of my bed, head first t4ying to "catch the shadow person" who keeps trying to wake me up!

 

Fortunately, I have managed, somehow, to not "land" on either of my two scull "plugs" where the leads go into my brain. I am sore and bruised, and just like my PD, which I've had now for 35 yrs, I see no end to my REM sleep behavioral disorder. They both progress, on and on and on, worseand worse and worse!

 

It bothers me tremendously not to be able to share the same bedroom with my wife, but her safety and welfare are more important to me!

 

Regards,

 

Jim Evridge "AKA:SILVERFOXX_FIGHTING_BACK" STILL!!!!!

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Jim, you are right that this recent report only included 10 patients. Have you been to a sleep expert for treatment recently or sought a second opinion? Have you had the location of your DBS leads checked and the settings?

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Dr. Okun,

 

Thanks for your speedy reply! Per my neurosurgeon AND Medtronic my leads are at optimal placement in my brain. The reason for so long a time between implants, The unilateral Soletra implant, for my left side symptoms was actually mitigating the symptoms on both sides of my body! Medtronic referred to it as "cross talking". A "rare event that occurs from time to time." Before the surgery I had no sleep problems that many others complained of. In the 27 years between my first visible symptom in 1976, a slight tremor in the little finger of my left hand, up until the 1st implant in 2003, I can honestly say that I had no sleep problems. However, after the 1st DBS/STN my wife reported that I was doing something I had never done before, I began talking in my sleep. Then, after about 6 months, my legs began flailing. Gradually at first,, then they became more active/violent as time went by This soon spread to my arms and hands. I equated this REMSBD progression to the progression of my right side PD symptoms. Mere coincidence? An uneducated NO coincidence from me! I firmly believe, in my PD anyway, there is a corelationship betweeen my REMSBD and my PD. Per my MDS, there may be a remote possibility since so little is known about PD.

.

re: Sleep study. In 2008 I began seeing a pulmonologist/sleep disorder doctor. Based on my history, he rx'd the Clonazepam and scheduled a sleep study. The study never happened because my youngest son died and I never got around to rescheduling the study. That was 2008, fast forward to June, 2010, my 2nd DBS/STN implant in my left brain for my right side PD symptoms. Like the first, this implant was also successful. When both sides are on, no one would suspect that I've had a neurodegenerative disease for the last 35 years of my life! BTW: I am considered YOPD. I was 31 when my symptoms became visible.

 

The only problem? My REMSBD seems to have escalated to new hrights (lows)! I don't dare have a lamp on a nightstand by my bed, I've broken too many! My wife and I relocated last March for health reasons. I was dx'd with end stage emphysema. So today I have new docs, a new hospital. and a new pulmo/ssleep disorder doc, who I trust implicitly. So I will be having a sleep study done soon!

 

Regards,

 

Jim Evridge "AKA:SILVERFOXX_FIGHTING_BACK"

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Thanks for the great message. I hope your sleep study and future sleep treatment get you and your wife back in the same bed!

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