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Rositsa Poryazova, MD; Daniel Waldvogel, MD; Claudio L. Bassetti, MD

Arch Neurol. 2007;64(10):1524-1527.

Objective  To report the occurrence of adult-onset (de novo) sleepwalking in a series of 6 patients with idiopathic Parkinson disease (PD).

Design  Case series.

Setting  Outpatient clinic for movement disorders.

Patients and Methods  Of 165 consecutive patients with PD seen for 2 years, 6 patients with adult-onset sleepwalking were identified. These patients underwent a systematic clinical assessment of their extrapyramidal and sleep problems, which included standard questionnaires, clinical examination, and estimation of PD severity (motor score of the Unified PD Rating Scale and Hoehn and Yahr stage). Five of 6 patients had a video-polysomnography recording that was scored according to international criteria.

Results  Patients included 3 women and 3 men with a mean (±SD) age of 66 ± 12 years (range, 46-78 years). The mean (±SD) Unified PD Rating Scale score was 25 ± 9 (range, 10-35) and the mean (±SD) Hoehn and Yahr stage was 2.5 ± 1.0 (range, 1.0-4.0). Medications in these patients included levodopa (n = 6), dopamine agonists (n = 4), selective serotonin reuptake inhibitor antidepressants (n = 3), and hypnotics (n = 3). All patients had at least 1 concomitant sleep-wake disorder, including rapid eye movement sleep behavior disorder (n = 4) and insomnia (n = 4). In 2 of 6 patients, the latency between onset of PD and appearance of sleepwalking was more than 4 years.

Conclusion  Neurodegenerative changes associated with PD at the brainstem level can affect the "ascending" control of state transition (leading to dissociated arousals from non–rapid eye movement and/or rapid eye movement sleep) and the "descending" control of locomotion and muscle tone, together giving rise to various sleep-associated behavioral disturbances including sleepwalking, rapid eye movement sleep behavior disorder, and overlap parasomnia.

Author Affiliations: Department of Neurology, University Hospital Zurich, Zurich, Switzerland.