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Parkinsonís Disease With Freezing of Gait Associated with REM Sleep Disturbance

People with Parkinson’s disease (PD) who experience freezing of gait, a common symptom of the disease as it advances, are more likely to experience disturbed rapid eye movement (REM) sleep, according to a study published in the August 14 online edition of Neurology.

REM sleep is best known as the dream phase of sleep, during which people experience rapid movement of the eyes, but very little activity in other muscles. When this phase of sleep is disturbed, it is called REM sleep behavior disorder (RBD). People who experience RBD show increased movement during REM sleep; they act out their dreams in ways that can be disruptive and cause harm to themselves or bed partners.

RBD is associated with the development of Parkinson’s disease and may be an early non-motor sign of the disease. Another less severe sleep disturbance, REM sleep without atonia, has also been associated with PD.

The study explored the relationship of PD with freezing of gait and increased muscle activity during REM sleep. It was led by Aleksandar Videnovic, M.D., M.Sc., Assistant Professor of Neurology at Northwestern University Feinberg School of Medicine, who was granted the 2008 Parkinson’s Disease Foundation (PDF)/American Academy Brain Foundation (ABF) Clinician-Scientist Development Award to study sleep patterns in people with PD.

The team of researchers conducted sleep studies, in which brain, heart, breathing and muscle activity are monitored, in four groups: 1) people with RBD only 2) people with PD with freezing of gait; 3) people with PD without freezing of gait; and 4) controls.

Results

  • Study participants with PD and freezing of gait had threefold greater muscle activity during REM sleep than participants with PD without freezing of gait.
  • Participants with PD with freezing and participants with REM sleep behavior disorder showed similar increased muscle activity during REM sleep.

What Does It Mean?

This study provides further evidence of a relationship between freezing and increased muscle activity during REM sleep.

It is important for two additional reasons. First, it suggests that sleep studies may be able to identify which people with PD are more likely to experience freezing of gait. This will have to be confirmed in other studies. Second, it may shed light on the biological mechanism of freezing. It is possible that RBD and freezing of gait share the same biological mechanism, as they tend to co-occur.

Currently, freezing of gait can be a very disabling complication of PD. In most cases, standard Parkinson's treatment does not improve this symptom, and as it progresses, people may experience frequent falls.  Studies like this which shed light on the biological mechanism of freezing, may help us to find new treatments.

See Profile on Dr. Videnovic from 2008

Learn More About the PDF-ABF Award


Reference: Videnovic A, Marlin C, Alibiglou L, et al. (2013) Increased REM sleep without atonia in Parkinson disease with freezing of gait. Neurology DOI: 10.1212/WNL.0b013e3182a4a408 http://dx.doi.org/10.1212/WNL.0b013e3182a4a408

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Source Date: Sep 09 2013