A case series and systematic review of rapid eye movement sleep behavior disorder outcome after deep brain stimulation in Parkinson's disease

• Published in: Sleep medicine 2021-01, Vol.77, p.170-176
• Main Authors: Cavalloni, Fabian, Debove, Ines, Lachenmayer, M. Lenard, Krack, Paul, Pollo, Claudio, Schuepbach, W.M. Michael, Bassetti, Claudio L.A., Bargiotas, Panagiotis
• Format: Article
• Language: English
• Subjects: Deep Brain Stimulation; Dream enactment; Humans; Parkinson Disease - complications; Parkinson Disease - therapy; Parkinson's disease; Prospective Studies; Rapid eye movement sleep without atonia; REM muscle activity; REM sleep Behavior disorder; REM Sleep Behavior Disorder - therapy; Sleep, REM
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2020.11.025

REM-sleep behavior disorder (RBD) is a parasomnia and a common sleep disorder in Parkinson's disease (PD). While deep brain stimulation (DBS) is an established treatment for advanced PD with beneficial effects on cardinal PD motor symptoms, the data on the impact of DBS on RBD are limited and often controversial. We reviewed published articles that reported on RBD in the context of DBS surgery via systematic PubMed search. We identified 75 studies and included 12 studies, involving a total of 320 subjects, in our review. Results in respect to EMG activity outcome after subthalamic stimulation are inconsistent. We found no study that reported on RBD outcome after pallidal DBS and no DBS study quantified complex behavior during REM sleep. We also added data on RBD outcome after subthalamic (N = 4 patients) or pallidal (N = 3 patients) DBS from patients with PD with RBD, obtained as part of a prospective DBS study in our centre. Our case series showed an increase of complex behavior during REM (CB-REM) after surgery, independent of DBS target. Conversely, we found a trend towards increasing REM sleep without atonia (RSWA) in subthalamic-stimulated patients and a trend towards decreased RSWA in pallidal stimulated patients. We conclude that CB-REM and RSWA might represent two distinct elements in RBD and should be assessed separately, especially in studies that report on RBD outcome after treatment interventions. Further, larger, prospective, controlled studies in different DBS targets, reporting separately on the different RBD modalities, are needed. •An increasing number of studies report on RBD outcome after deep brain stimulation, however, results are inconsistent.Our findings suggest the followings:•REM sleep without atonia is not significantly affected by deep brain stimulation.•Complex behavior in REM sleep increases after deep brain stimulation independent of the stimulation target.•RBD studies should report separately on muscle tone and complex behavior during REM sleep, especially if treatment outcome is studied.