Center for Translational Neuroscience Distinguished Speaker Series Rayford Auditorium, Biomed II Bldg. Tuesday, September 11, 12 noon "Parasomnias: REM sleep behavior disorder and Parkinsonism, and Zolpidem-Induced Sleep Related Eating Disorder" Carlos H. Schenck, MD Associate Professor of Psychiatry University of Minnesota Medical School Minneapolis, Minnesota
Parasomnias are defined as the behavioral, experiential and autonomic nervous system disorders emerging during entry into sleep, within sleep, or during arousals from any stage of sleep. Instinctual behaviors--locomotion, eating, sex, and aggression--are often pathologically released with parasomnias, as found with sleepwalking, sleep related eating disorder (SRED), sexsomnia, and rapid-eye-movement (REM) sleep behavior disorder (RBD). RBD, first identified in 1985, primarily affects males >50 years old, who demonstrate by electromyography the loss of the customary, generalized muscle atonia of REM sleep, and who act-out distinctly altered, aggressive and violent dreams that result in injury to self and spouse. Longitudinal studies from two centers have found that 65% and 45%, respectively, of patients initially diagnosed with “idiopathic RBD” will eventually-- and almost exclusively--develop a parkinsonian disorder at a mean interval of 13 years and 11.5 years, respectively, from the onset of RBD. The motor atonia nuclei and phasic motor nuclei active during REM sleep have strong reciprocal connections to extrapyramidal nuclei involved in parkinsonian disorders, thereby establishing a neuroanatomic and neurophysiologic link between RBD and parkinsonism. The other parasomnia to be discussed in the seminar is SRED, a female-predominant disorder that was first identified in 1991 and is characterized by longstanding, recurrent episodes of involuntary binge-eating during sleep, usually with partial or minimal consciousness, and with major morbidity such as weight gain/obesity and dental complications. SRED is considered to be a “final common pathway disorder” that can be idiopathic or result from sleepwalking, sleep apnea, restless legs syndrome—and medications, particularly zolpidem therapy of insomnia. The link between zolpidem and SRED will be a focus of the presentation.