No.2 Parkinson's disease with narcolepsy and nocturnal delirium Arii et al.
Patients with Parkinson's disease for whom narcolepsy and nocturnal delirium appeared to be dose-dependent symptoms Yoshiharu Ari , M.D.#1, Yoshiko Shibuta, M.D.#1, Kazuyuki Kawamura, M.D. #1, Kotaro Asanuma, M.D.#2, Yuishin Izumi M.D. #2, Toshio Inui, M.D. #1, Takao Mitsui, M.D. #1 #1. Department of Neurology, Tokushima National Hospital, National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa, #2. Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-3, Received 3 February 2011 ; received in received from 28 February 2011 ; accepted 7 March 2011 Abstract
The patient was a 76-year-old woman who had suffered Parkinson's disease for eight years. Nine mg of ropinirole, a dopamine agonist, was taken four times a day. Gait disturbance worsened, and she was hospitalized. She experienced nocturnal delirium, burst-related sleep, a tendency towards somnolence and sleep disturbance. The ropinirole was reduced to 4 mg, four times a day. The narcolepsy disappeared the next day, and the daytime somnolence also decreased. Ropinirole-related nocturnal delirium with a tendency towards somnolence, and burst-related sleep seemed to be dose-dependent.
Keywords: ropinirole hydrochloride, excessive daytime sleepiness, Parkinson’s disease, dose responsive
ropinirole hydrochloride 9 mg/day, Selegiline hydrochloride 25mg/day on admission. Cataplectic In patients with Parkinson's disease, narcolepsy may narcolepsy developed during daytime rehabilitation sometimes present. Narcolepsy as a side effect of use just after hospitalization. Nocturnal delirium and of dopamine agonists has attracted attention insomnia developed at the same time. The ropinirole recently. We report a case in which cataplectic sleep was reduced to 4mg/day from February 14. The and nocturnal delirium were complicated in patients sudden daytime sleepiness during rehabilitation with Parkinson's disease while they were taking a than the next day disappeared. The nocturnal delirium also decreased. The Epworth SleepinessScale decreased from 20 points to 8 points.
Case report
A 76-year-old woman noticed gait disturbance from about 2003. She received a diagnosis of Parkinson's A case that caused a traffic accident was described in disease from her local doctor and was treated.
an initial report on daytime sleepiness attacks Vorlage and gait disturbance worsened from about caused by a non-ergot system dopamine agonist [1].
May, 2009. Left coxalgia developed from about The tendency towards somnolence of patients with December, 2010. She was hospitalized in Tokushima Parkinson's disease in the daytime is associated with National Hospital on January 7, 2011. On admission, disease severity, a tendency to depression, and large the symptoms of parkinsonism were remarkable.
doses of a dopamine agonist [2,3]. The average She was not able to walk due to the left coxalgia and frequency of occurrence is 15.5%; 8% at the onset of vorlage. The Hoehn & Yahr stage was 4 and UPDRS illness and 21% four years after the onset [4].
was 123. The anti-parkinson agents included Patients with Parkinson's disease have much sleep Levodopa benserazide hydrochloride 300mg/day, fragmentation [5]. This may cause sleep disturbance Correspondence to: Yoshiharu Arii, M.D., Tokushima National Hospital, National Hospital Organization, 1354 Shikiji, Kamojima, Yoshinogawa,
Tokushima 776-8585 Japan. Phone: +81-883-24-2161 Fax : +81-883-24-8661
No.2 Parkinson's disease with narcolepsy and nocturnal delirium Arii et al.
at night, but it does not seem to cause somnolence in the daytime. Ropinirole shortened the initiation of sleep latency in a control study of healthy subjects[6]. As for this, the drug may be associated with somnolence in the daytime. This patient took 9mg ropinirole /day for several years. She did not have somnolence or delirium before then. Somnolence in the daytime and nocturnal delirium developedseveral days after hospitalization. Therefore, these side effects could be delayed adverse eventsassociated with taking ropinirole. Nocturnal delirium caused by a dopamine agonist remedy may be more frequent than is conventionally reported [7].
It is reported that ropinirole induces psychosis [8].
Our patients showed improvement in somnolence and nocturnal delirium with a dose reduction of their dopamine agonist in the daytime. In other words, somnolence and nocturnal delirium in the daytime were delayed type adverse events caused by ropinirole, and were improved by drug reduction immediately.
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2.Hobson DE, Lang AE, Martin WR, et al. Excessive Parkinson’s disease: a survey by the Canadian movement disorders group. JAMA 2002; 287: 455-63.
3. Suzuki K, Miyamoto T, Miyamoto M, et al. Excessive daytime sleepiness and sleep episodes in Japanese patients with Parkinson's disease. J Neurol Sci 2008; 271:47-52.
4. Comella CL. Sleep Disorders in Parkinson’s Disease: An Overview. Movement Disorders 2007; 22 (Suppl): S367–S373. 5. Poter B, Macfarlane R, Wallker R. The frequency and nature of sleep disorders in a community-based population of patients with Parkinson’s disease. Eur J Neurol 2008; 15: 50-4.
6. Ferreira JJ, Galitzky M, Thalamas C, et al. Effect of ropinirole on sleep onset: a randomized placebo controlled study in healthy volunteers. Neurology 2002; 58: 460–462.
7.Georgiev D, Danieli A, Ocepek L, et al. Othello syndrome in patients with Parkinson's disease. Psychiatr Danub 2010; 22: 94-98.
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