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Sleep Homeostasis in Parkinson's Disease

Sponsor
Salvatore Galati (Other)
Overall Status
Completed
CT.gov ID
NCT02200887
Collaborator
(none)
48
Enrollment
1
Location
21
Duration (Months)
2.3
Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Parkinson's disease is characterized in the advanced phases by an altered response to dopaminergic therapy for the occurrence of abnormal movements called dyskinesias, that worsens the quality of life of the patient and exposes him to comorbidities. Several data show a reduction in the amount of slow wave sleep that correlates inversely with disease duration. Since this stage of sleep is linked to mechanisms of deletion of superfluous information the investigators hypothesize that the onset of dyskinesias is related to such alteration of sleep.

-This study is aimed to investigate, by means of high-density electroencephalography (hd-EEG), the sleep and in particular the slow wave in order to clarify the relations with the development of dyskinesias.

Condition or Disease Intervention/Treatment Phase

    Detailed Description

    Wakefulness in PD is frequently interrupted by sleep episodes, even rapid eye movement sleep (REM), whilst nocturnal sleep is disturbed by abnormal motor activity interference, such as REM sleep behaviour disorder (RBD) or periodic limb movements (PLMS). Several lines of evidence have suggested a close relation between sleep-wake changes and dopaminergic degeneration in PD(1-7) while sleep disorders commonly precede the clinical motor onset by many years (8,9). On the other hand, morning motor performance improvement is frequently mentioned by patients, mainly in those with long disease duration and motor fluctuation (10,11). Of note, the same state of vigilance can profoundly influence some clinical PD features (for instance rigidity) as well as basal ganglia neuronal activity(12).

    Few reports have shown changes in sleep architecture: a reduction of the amount of SWS in parallel with disease duration (13-15) has been observed, but no study, so far, has addressed how sleep may impact on LID. Once these abnormal movements develop, they are difficult to treat and negatively affect the quality of life and the treatment costs of PD patients (16,17). Although levodopa represents, so far, the more effective treatment for PD patients (18,19) to ameliorate the cardinal signs such as bradykinesia/akinesia and rigidity (20), as the disease progresses, these benefits are in some measure abolished by the emergence of dyskinesia (21). During the early stages PD patients experience a rather satisfying quality of life that is impeded in the advanced stages by the emerging of these involuntary movements frequently at the peak of the levodopa effect (16,22,23). In other words, when the patients experience these motor complications (shortening motor response and development of dyskinesia) the delivery of levodopa without inducing dyskinesia becomes increasingly difficult (21,24-27).

    Several efforts have been made in order to find "pure" anti-dyskinetic drugs that are able to uncouple the anti-akinetic effect from the dyskinetic response. Serotoninergic receptor agonists were claimed to be drugs against dyskinesia (28), however, it was observed that they may also impair levodopa efficacy (29-31). As of today, no clinical effective therapies are able to alleviate dyskinesia without worsening parkinsonism.

    Great efforts have been made to clarify LID pathogenesis, emphasizing the role of pulsative stimulation of striatal receptors by dopaminergic treatment (25) and more recently, on molecular changes of postsynaptic (32,33) or presynaptic mechanisms (34). Although no conclusive results on LID pathogenesis have been achieved, indeed disease duration (i.e. the degree of dopaminergic degeneration) rather than long-term use of levodopa, seems to play a crucial role (22,23). This notion can be inferred from clinical practice, but is also evident in MPTP-induced parkinsonism in humans in which the extended dopaminergic lesion caused within a few days the development of dyskinesias undistinguishable from those in the idiopathic form (35).

    General Aim:

    The study is aimed 1) to define abnormal cortical synaptic homeostasis, measured by means of SWS and waking EEG evoked responses, as key components for the development of LID; 2) to analyse the impact of anti-dyskinetic effect of rTMS on the SWA in additional ten PD patient with LID.

    Specific aims:

    1. To compare, in the four groups of subjects (control, de novo, advanced without dyskinesia, and advanced with dyskinesia), changes of the EEG features of NREM sleep: slow wave/slow oscillation and sleep spindles. A significant reduction of the physiological reduction of SWA in dyskinetic patients in comparison with the other groups is expected.

    2. To identify the homeostatic reduction of cortical synaptic strength (downscaling) in the four categories of subjects by comparing late sleep (i.e. towards morning) SWA with early sleep (i.e. at the beginning of the night) SWA as well as by comparing the overnight changes in the amplitude of EEG somatosensory, auditory and visual evoked responses recorded before and after sleep. The study is aimed to demonstrate the reduction/absence of a physiological downscaling in dyskinetic patients versus the other groups.

    3. To analyse the effect of rTMS on SWA of PD patients with LID in order to demonstrate a recovery of physiological downscaling of SWA in these patients parallel to the reduction of dyskinesia.

    Study Design

    Study Type:
    Observational
    Actual Enrollment :
    48 participants
    Observational Model:
    Case-Control
    Time Perspective:
    Cross-Sectional
    Official Title:
    Role of Sleep Homeostasis in the Development of the L-Dopa Induced Dyskinesias in Patients With Parkinson's Disease
    Study Start Date :
    Sep 1, 2013
    Actual Primary Completion Date :
    Jun 1, 2015
    Actual Study Completion Date :
    Jun 1, 2015

    Arms and Interventions

    Arm Intervention/Treatment
    Advanced Parkinsons Disease

    Polysomnogram
    Parkinsons Disease with Dyskinesia

    Polysomnogram
    De novo Parkinsons Disease

    Polysomnogram
    Healthy Volunteers

    Polysomnogram

    Outcome Measures

    Primary Outcome Measures

    1. Slow wave sleep [1 night]

      Percentage of total sleep classified as slow wave sleep

    Secondary Outcome Measures

    1. Amplitude of slow waves during sleep [1 Night]

      Reduction of homeostatic synaptic plasticity during the time of sleep

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    45 Years to 75 Years
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    Yes
    Inclusion Criteria:
    • clinical characteristics of the patients must be according the UK (United Kingdom) Brain Bank
    Exclusion Criteria:

    • anamnestic obstructive sleep apneas syndrome

    • known cognitive deterioration or with MMSE (Mini-Mental State Examination) ≤24/30

    • depression ≥ 20 of the BDI scale (Beck Depression Inventory)

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Ospedale Regionale di Lugano Lugano Ticino Switzerland 6903

    Sponsors and Collaborators

    • Salvatore Galati

    Investigators

    • Principal Investigator: Salvatore Galati, MD, Ospedale Regionale di Lugano

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    Responsible Party:
    Salvatore Galati, MD, head of service, Ospedale Civico, Lugano
    ClinicalTrials.gov Identifier:
    NCT02200887
    Other Study ID Numbers:
    • EOC-NSI.12.01
    First Posted:
    Jul 25, 2014
    Last Update Posted:
    Apr 9, 2018
    Last Verified:
    Apr 1, 2018
    Keywords provided by Salvatore Galati, MD, head of service, Ospedale Civico, Lugano
    Dyskinesia
    Slow Wave Sleep
    Additional relevant MeSH terms:
    Parkinson Disease

    Study Results

    No Results Posted as of Apr 9, 2018