Sleep disorders appear to be first sign of serious neurological diseases

Sleep disorders are often the first sign of serious neurological diseases. Neurologists should inquire extensively about the quality of their patients' sleep. This point was emphasized by experts at the Congress of the European Academy of Neurology in Lisbon. In rare neuroimmunological diseases sleep and wakefulness also frequently play an important role.

If patients report suffering from sleep disorders, alarm bells should go off for neurologists. These conditions are often a first sign of serious neurological diseases. This is true of abnormal sleep behavior as well as excessive sleepiness or insomnia. "Two thirds of the population suffering from REM sleep disorders later develop Parkinson's disease, Lewy body dementia or multiple system atrophy," Dr Konstanze Philipp (Munster) reported at the 4th Congress of the European Academy of Neurology (EAN) in Lisbon.

REM sleep behavior disorder (Schenk syndrome) manifests itself in the loss of what is known as physiological muscle atonia during REM sleep. This paralysis causes muscles to relax in healthy sleeping individuals who are dreaming. If this inhibition is lost, the affected individuals move, cry out, and flail around with their arms and legs during the REM sleep and can injure themselves and their partner. In combination with certain biological markers, these neurodegenerative diseases could be diagnosed in the future years before the first consciously perceived symptoms occur. However, anyone looking through health records for a patient's documented sleep history seldom finds one. Dr Philipp: "We have to raise awareness on this matter. Improved early detection in the future could also improve the therapeutic results." For instance, there is the well-founded hope that new therapeutic approaches can prevent, or at least delay, the breakout of Parkinson's disease, provided treatment begins very early on.

Active while sleeping - possible sign of autoimmune disease

Insomnia or poor sleep quality can also indicate rare neuroimmunological illnesses caused by antibodies. Dr Philipp illustrated this point at the EAN Congress by citing three cases as examples. Case 1: A 69-year-old man reported he had recently been very active in his sleep, causing him to fall out of bed twice. He went on to say that his sleep was no longer restful and that he kept falling asleep involuntarily during the day. A few months later, the man developed gait abnormalities, had ocular motor problems, and also chorea-like movement disorders entailing involuntary, jerky and irregular movements. It was not until then that he was diagnosed with an autoimmune disorder discovered just a few years ago, namely, anti-IgLON5 disease or autoimmune encephalopathy with parasomnia and obstructive sleep apnoea. The syndrome is characterized by a complex, advanced sleep disorder and is triggered by antibodies against IgLON5, a neural cell adhesion molecule.

Sleepiness during the day or insomnia as initial signals

The two other examples that Dr Philipp cited from her case analyses are as follows. Case 2: After a long investigation, a 33-year-old man was diagnosed with Ma2 antibody encephalitis caused by a germ cell tumor. A year and a half prior to the diagnosis, the young man had already been suffering from extreme daytime sleepiness, hypnagogic hallucinations, and sleep paralysis. It was not until a sleep lab determined he had narcolepsy originating in the central nervous system that his physicians began zeroing in on the actual problem and the right diagnosis. Case 3: For a 51-year-old patient, sleep disorders were also the first signals of a severe neuroimmunological disease. He suffered from insomnia for two years. Then various muscular symptoms such as myalgia, cramps and fasciculations occurred. At that point his physicians finally diagnosed him as having Morvan's syndrome, a type of autoimmune encephalitis associated with antibodies against the Contactin-associated protein 2 (CASPR2).

Dr Philipp made this appeal: "Asking questions, listening and documenting are least expensive and easiest ways of diagnosing these complex diseases. We should use them. The therapeutic approaches are still expandable. Nonetheless, early detection is essential, especially for neurodegenerative disorders."

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Comments

  1. TONY WILLIAMS TONY WILLIAMS United States says:

    Where can we be seen about this?

  2. Rita Shaw Rita Shaw United States says:

    How many fibromyalgia and ME are actually one of the above mentions diseases? I know my insominia predated my fibromyalgia disease by 2 years? I Wore a app that recorded sleep wake cycles and recorded sounds at home for 10 days,  I was waking up constantly without even knowing it? One night I was recorded talking, coughing, mumbling etc. Over 200 times?? They said I wasn't  getting deep sleep, my cycles were being interrupted  for some reason. I'd think  I slept 11 hours get to work, sit at my desk, and fall asleep over and over, until I jerked myself and woke or security called me and said " Rita your doing it again! Falling asleep on the job several times today already) talk about embarrassing,  I worked front desk of hospital. This was in 2004/5 they noted insomnia in my medical record. But Even though I asked abt  sleep study many times they never took it as serious as they  should. Because either way my body and mind became over exhausted,  broke down..caught  MRSA on job, than pneumonia, than chronic glomerulonephritis kidney desease, hypokelma,  anterior pituitary disorder,  Periherial neuropathy, Reiters arthritis,? Now with all these issues not even naming other half abnormalities, do you really think it's just fibromyalgia? Funny because joint pain has gone into remission or healed from car accident  which caused  severe multilevel  spinal pain, and whiplash MRI showed multi level stenosis.....I remember them distinctly telling me that fibromyalgia was a very painful syndrome, but wouldn't effect or damage my health in any serious way, we just have to treat the symtoms,  as best we can....

    • Daniel Tache Daniel Tache United States says:

      Great comments and insights Rita.  I am a dentist but I have a practice limited to the treatment of sleep disorders and orofacial pain.  In 2008 I entered a 3 year Masters program in orofacial pain and my department chairman, Dr. Noshir Mehta at Tufts U. suggested that I consider doing research in sleep disorders.  I did not realize at the time just how correct he was in suggesting to me that orofacial pain and sleep problems often co-exist.  I studied under a psychologist on staff at Mass General Hospital who was considered one of the real experts in Fibromyalgia.  Long story short, there is a substantial body of evidence that supports the hypothesis that Fibromyalgia (symptoms) is most often due to the presence of sleep-related breathing disturbances which cause up-regulation  of the central nervous system and the consequent symptoms due to chronic flight-and-fight condition.  Researchers and clinicians such as Drs. Avrum Gold and Christian Guilleminault got it right.  Here's a link to an excellent article by Dr. Gold (a student of Dr. Guilleminault -Stanford Sleep) - if you can, get hold of this and it will tie up a lot of loose ends for you (but I don't think that you have many...you seem to have good intuition about all of this!  Here's a link to that article:  www.sciencedirect.com/.../S1087079210001346
      Regards,
      Dan Tache

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