tailieunhanh - Parkinson disease and related disorders part - part 7

Khiếu nại ngủ được thường xuyên và đáng kể làm giảm chất lượng cuộc sống ở những bệnh nhân bị bệnh Parkinson (PD). Lắng nghe bệnh nhân PD, là sớm tiết lộ rằng mệt mỏi và buồn ngủ là những khiếu nại chính độc lập của bất kỳ loại thuốc chữa bệnh và khuyết tật vận động. | Handbook of Clinical Neurology Vol. 83 3rd series Parkinson s disease and related disorders Part I . Koller E. Melamed Editors 2007 Elsevier . All rights reserved Chapter 15 Sleep in Parkinson syndromes CLAUDIA TRENKWALDER1 AND BIRGIT IIOGI. 1 Paracelsus Elena-Klinik Kassel and University of Gottingen Germany 2Department of Neurology Medical University of Innsbruck Austria . Introduction and pathophysiology of sleep in Parkinson syndromes Sleep complaints are frequent and substantially impair quality of life in patients with Parkinson s disease PD . Listening to PD patients it is soon revealed that fatigue and sleepiness are major complaints independent of any medication and motor disability. Although previous research on sleep and daytime sleepiness in PD primarily focused on nocturnal sleep disturbance and pharmacological therapy recent neuropathological publications demonstrate that neurodegeneration involves sleep regulation and daytime alertness to a large degree Braak et al. 2003 . Severely disrupted sleep and rapid-eye movement REM sleep disturbances are early signs of neurodegeneration with involvement of the brainstem with Lewy bodies. First the neurodegenerative process starts in the lower brainstem areas according to the six progressive stages described by Braak and collaborators Del Tredici et al. 2002 Braak et al. 2003 . REM sleep behavior disorder RBD may be a preclinical and premotor sign of PD or other Parkinson syndromes. Therefore the observation of early changes in sleep may be of particular importance especially if neuro-protective agents may be available in the future. Second the behavioral respiratory and motor system phenomena accompanying the disease may produce nocturnal symptoms. Third the medications used as treatment may induce new symptoms such as nightmares nocturnal movements or increased wakefulness. In addition to the primary cause of PD the loss of dopaminergic neurons in the substantia nigra serotonergic neurons .