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  • Print publication year: 2011
  • Online publication date: February 2011

Chapter 31 - Brain tumors, infections, and other CNS causes of sleepiness

from Section 3 - Medical, Psychiatric and Neurological Causes Of Sleepiness

Summary

Restless legs syndrome and periodic limb movement disorder are common neurological entities that may be associated with insomnia and excessive daytime sleepiness. This chapter reviews the clinical features, natural history, laboratory investigations, genetics, pathology, and management of primary restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Large epidemiological surveys have shown that self-reported symptoms of RLS were correlated with sleepiness. Electrodiagnostic testing with nerve conduction studies and electromyography are useful to detect subtle peripheral neuropathies. Several factors suggest that impaired dopaminergic function and iron homeostasis underlie the pathophysiology of RLS. One study demonstrated that dopaminergic treatment of RLS patients improved both RLS severity and sleepiness as measured by multiple sleep latency test (MSLT) score. Considerable research has been directed towards elucidating the basic mechanisms and optimizing the management of RLS and PLMD.

References

1. PosnerJ B, PlumF. Plum and Posner's Diagnosis of Stupor and Coma (4th Ed). Oxford, New York: Oxford University Press, 2007.
2. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd Ed. Westchester, IL: American Academy of Sleep Medicine, 2005.
3. EspanaR A, ScammellT E. Sleep neurobiology for the clinician. Sleep, 2004; 27:811–20.
4. SaperC B, ScammellT E, LuJ. Hypothalamic regulation of sleep and circadian rhythms. Nature, 2005; 437:1257–63.
5. MullerH L, HandwerkerG, GebhardtU, et al. Melatonin treatment in obese patients with childhood craniopharyngioma and increased daytime sleepiness. Cancer Causes Control, 2006; 17:583–89.
6. PorettiA, GrotzerM A, RibiK, et al. Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev Med Child Neurol, 2004; 46:220–29.
7. MullerH L, Muller-StoverS, GebhardtU, et al. Secondary narcolepsy may be a causative factor of increased daytime sleepiness in obese childhood craniopharyngioma patients. J Pediatr Endocrinol Metab, 2006; 19(Suppl 1):423–29.
8. Van Der KlaauwA A, DekkersO M, PereiraA M, et al. Increased daytime somnolence despite normal sleep patterns in patients treated for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab, 2007; 92:3898–903.
9. MarcusC L, TrescherW H, HalbowerA C, et al. Secondary narcolepsy in children with brain tumors. Sleep, 2002; 25:435–39.
10. KrahnL E, BoeveB F, OliverL, et al. Hypocretin (orexin) and melatonin values in a narcoleptic-like sleep disorder after pinealectomy. Sleep Med, 2002; 3:521–23.
11. BealM F, KleinmanG M, OjemannR G, et al. Gangliocytoma of third ventricle: hyperphagia, somnolence, and dementia. Neurology, 1981; 31:1224–28.
12. Van Der KlaauwA A, BiermaszN R, PereiraA M, et al. Patients cured from craniopharyngioma or nonfunctioning pituitary macroadenoma (NFMA) suffer similarly from increased daytime somnolence despite normal sleep patterns compared to healthy controls. Clin Endocrinol (Oxf), 2008; 69:769–74.
13. MaT K, AngL C, MamelakM, et al. Narcolepsy secondary to fourth ventricular subependymoma. Can J Neurol Sci, 1996; 23:59–62.
14. SchoenhuberR, AngiariP, PesericoL. Narcolepsy symptomatic of a pontine glioma. Ital J Neurol Sci, 1981; 2:379–80.
15. StahlS M, LayzerR B, AminoffM J, et al. Continuous cataplexy in a patient with a midbrain tumor: the limp man syndrome. Neurology, 1980; 30:1115–18.
16. OnofrjM, CuratolaL, FerracciF, et al. Narcolepsy associated with primary temporal lobe B-cells lymphoma in a HLA DR2 negative subject. J Neurol Neurosurg Psychiatry, 1992; 55:852–53.
17. DauvilliersY, AbrilB, CharifM, et al. Reversal of symptomatic tumoral narcolepsy, with normalization of CSF hypocretin level. Neurology, 2007; 69:1300–01.
18. NakanoH, OgashiwaM. Complete remission of narcolepsy after surgical treatment of an arachnoid cyst in the cerebellopontine angle. J Neurol Neurosurg Psychiatry, 1995; 58:264.
19. DalmauJ, GrausF, VillarejoA, et al. Clinical analysis of anti-Ma2-associated encephalitis. Brain, 2004; 127:1831–44.
20. ComptaY, IranzoA, SantamariaJ, et al. REM sleep behavior disorder and narcoleptic features in anti-Ma2-associated encephalitis. Sleep, 2007; 30:767–69.
21. Rojas-MarcosI, GrausF, SanzG, et al. Hypersomnia as presenting symptom of anti-Ma2-associated encephalitis: case study. Neuro Oncol, 2007; 9:75–77.
22. DempseyO J, McGeochP, de SilvaR N, et al. Acquired narcolepsy in an acromegalic patient who underwent pituitary irradiation. Neurology, 2003; 61:537–40.
23. MeeskeK, KatzE R, PalmerS N, et al. Parent proxy-reported health-related quality of life and fatigue in pediatric patients diagnosed with brain tumors and acute lymphoblastic leukemia. Cancer, 2004; 101:2116–25.
24. SchmidtH, CohrsS, HeinemannT, et al. Sleep disorders are long-term sequelae of both bacterial and viral meningitis. J Neurol Neurosurg Psychiatry, 2006; 77:554–58.
25. SalahuddinN, BarrosoJ, LesermanJ, et al. Daytime sleepiness, nighttime sleep quality, stressful life events, and HIV-related fatigue. J Assoc Nurses AIDS Care, 2009; 20:6–13.
26. DarkoD F, McCutchanJ A, KripkeD F, et al. Fatigue, sleep disturbance, disability, and indices of progression of HIV infection. Am J Psychiatry, 1992; 149:514–20.
27. MoellerA A, OechsnerM, BackmundH C, et al. Self-reported sleep quality in HIV infection: correlation to the stage of infection and zidovudine therapy. J Acquir Immune Defic Syndr, 1991; 4:1000–03.
28. NormanS E, ChediakA D, KielM, et al. Sleep disturbances in HIV-infected homosexual men. AIDS, 1990; 4:775–81.
29. MorleseJ F, QaziN A, GazzardB G, et al. Nevirapine-induced neuropsychiatric complications, a class effect of non-nucleoside reverse transcriptase inhibitors?AIDS, 2002; 16:1840–41.
30. GuilleminaultC, MondiniS. Mononucleosis and chronic daytime sleepiness. A long-term follow-up study. Arch Intern Med, 1986; 146:1333–35.
31. WatsonN F, DohertyM J, ZuntJ R. Secondary narcolepsy following neurocysticercosis infection. J Clin Sleep Med, 2005; 1:41–42.
32. GreenbergH E, NeyG, ScharfS M, et al. Sleep quality in Lyme disease. Sleep, 1995; 18:912–16.
33. DinarelloC A, CannonJ G, WolffS M. New concepts on the pathogenesis of fever. Rev Infect Dis, 1988; 10:168–89.
34. KelleyK W, BlutheR M, DantzerR, et al. Cytokine-induced sickness behavior. Brain Behav Immun, 2003; 17(Suppl 1):S112–18.
35. ParraO, ArboixA, BechichS, et al. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med, 2000; 161:375–80.
36. TurkingtonP M, AllgarV, BamfordJ, et al. Effect of upper airway obstruction in acute stroke on functional outcome at 6 months. Thorax, 2004; 59:367–71.
37. HermannD M, SiccoliM, BruggerP, et al. Evolution of neurological, neuropsychological and sleep wake disturbances after paramedian thalamic stroke. Stroke, 2008; 39:62–68.
38. ScammellT E, NishinoS, MignotE, et al. Narcolepsy and low CSF orexin (hypocretin) concentration after a diencephalic stroke. Neurology, 2001; 56:1751–53.
39. VockJ, AchermannP, BischofM, et al. Evolution of sleep and sleep EEG after hemispheric stroke. J Sleep Res, 2002; 11:331–38.
40. BassettiC L. Sleep and stroke. Semin Neurol, 2005; 25:19–32.
41. NakajiK, IkedaA, OkaY, et al. Hypersomnia caused by isolated angiitis of the CNS. Intern Med, 2005; 44:883–85.
42. TsutsumiS, ItoM, YasumotoY, et al. Isolated angiitis in the hypothalamus mimicking brain tumor. Neurol Med Chir (Tokyo), 2008; 48:33–36.
43. RiveraV M, MeyerJ S, HataT, et al. Narcolepsy following cerebral hypoxic ischemia. Ann Neurol, 1986; 19:505–08.
44. TurkingtonP M, BamfordJ, WanklynP, et al. Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke. Stroke, 2002; 33:2037–42.
45. QureshiA I, GilesW H, CroftJ B, et al. Habitual sleep patterns and risk for stroke and coronary heart disease: a 10-year follow-up from NHANES I. Neurology, 1997; 48:904–11.
46. AutretA, LucasB, MondonK, et al. Sleep and brain lesions: a critical review of the literature and additional new cases. Neurophysiol Clin, 2001; 31:356–75.
47. IsekiK, MezakiT, OkaY, et al. Hypersomnia in MS. Neurology, 2002; 59:2006–07.
48. KatoT, KanbayashiT, YamamotoK, et al. Hypersomnia and low CSF hypocretin-1 (orexin-A) concentration in a patient with multiple sclerosis showing bilateral hypothalamic lesions. Intern Med, 2003; 42:743–45.
49. OkaY, KanbayashiT, MezakiT, et al. Low CSF hypocretin-1/orexin-A associated with hypersomnia secondary to hypothalamic lesion in a case of multiple sclerosis. J Neurol, 2004; 251:885–86.
50. VetrugnoR, StecchiS, PlazziG, et al. Narcolepsy-like syndrome in multiple sclerosis. Sleep Med, 2009; 10:389–91.
51. WangC Y, KawashimaH, TakamiT, et al. [A case of multiple sclerosis with initial symptoms of narcolepsy]. No To Hattatsu, 1998; 30:300–06.
52. HashiguchiS, OgasawaraN, MineH, et al. Multiple sclerosis with caudate lesions on MRI. Intern Med, 2001; 40:358–62.
53. SchluterB, AguigahG, AndlerW. [Hypersomnia in multiple sclerosis]. Klin Padiatr, 1996; 208:103–05.
54. SchraderH, GotlibsenO B, SkomedalG N. Multiple sclerosis and narcolepsy/cataplexy in a monozygotic twin. Neurology, 1980; 30:105–08.
55. BamerA M, JohnsonK L, AmtmannD, et al. Prevalence of sleep problems in individuals with multiple sclerosis. Mult Scler, 2008; 14:1127–30.
56. RammohanK W, RosenbergJ H, LynnD J, et al. Efficacy and safety of modafinil (Provigil) for the treatment of fatigue in multiple sclerosis: a two centre phase 2 study. J Neurol Neurosurg Psychiatry, 2002; 72:179–83.
57. ZifkoU A, RuppM, SchwarzS, et al. Modafinil in treatment of fatigue in multiple sclerosis. Results of an open-label study. J Neurol, 2002; 249:983–87.
58. StantonB R, BarnesF, SilberE. Sleep and fatigue in multiple sclerosis. Mult Scler, 2006;12:481–86.
59. KnudsenS, JennumP J, KorsholmK, et al. Normal levels of cerebrospinal fluid hypocretin-1 and daytime sleepiness during attacks of relapsing-remitting multiple sclerosis and monosymptomatic optic neuritis. Mult Scler, 2008; 14:734–38.
60. FrauscherB, EggR, BrandauerE, et al. Daytime sleepiness is not increased in mild to moderate multiple sclerosis: a pupillographic study. Sleep Med, 2005; 6:543–47.
61. HeesenC, NawrathL, ReichC, et al. Fatigue in multiple sclerosis: an example of cytokine mediated sickness behaviour?J Neurol Neurosurg Psychiatry, 2006; 77:34–39.
62. KaynakH, AltintasA, KaynakD, et al. Fatigue and sleep disturbance in multiple sclerosis. Eur J Neurol, 2006; 13:1333–39.
63. VetrugnoR, StecchiS, ScandellariC, et al. Sleep–wake and body core temperature rhythms in multiple sclerosis with fatigue. Clin Neurophysiol, 2007; 118:228–34.
64. TachibanaN, HowardR S, HirschN P, et al. Sleep problems in multiple sclerosis. Eur Neurol, 1994; 34:320–23.
65. MerlinoG, FratticciL, LenchigC, et al. Prevalence of ‘poor sleep’ among patients with multiple sclerosis: an independent predictor of mental and physical status. Sleep Med, 2009; 10:26–34.
66. DaleR C, de SousaC, ChongW K, et al. Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain, 2000; 123:2407–22.
67. HynsonJ L, KornbergA J, ColemanL T, et al. Clinical and neuroradiologic features of acute disseminated encephalomyelitis in children. Neurology, 2001; 56:1308–12.
68. KubotaH, KanbayashiT, TanabeY, et al. A case of acute disseminated encephalomyelitis presenting hypersomnia with decreased hypocretin level in cerebrospinal fluid. J Child Neurol,2002; 17:537–39.
69. YoshikawaS, SuzukiS, KanbayashiT, et al. Hypersomnia and low cerebrospinal fluid hypocretin levels in acute disseminated encephalomyelitis. Pediatr Neurol, 2004; 31:367–70.
70. KanbayashiT, GotoA, HishikawaY, et al. Hypersomnia due to acute disseminated encephalomyelitis in a 5-year-old girl. Sleep Med, 2001; 2:347–50.
71. GledhillR F, BartelP R, YoshidaY, et al. Narcolepsy caused by acute disseminated encephalomyelitis. Arch Neurol, 2004; 61:758–60.
72. SternB J, KrumholzA, JohnsC, et al. Sarcoidosis and its neurological manifestations. Arch Neurol, 1985; 42:909–17.
73. MartinJ B, RiskindP N. Neurologic manifestations of hypothalamic disease. Prog Brain Res, 1992; 93:31–40; discussion 40–42.
74. MatheJ F, MussiniJ M, NomballaisF, et al. [Unusual involvement of the CNS in a case of neuro-sarcoidosis (author's transl)]. Rev Neurol (Paris), 1980; 136:33–41.
75. RubinsteinI, GrayT A, MoldofskyH, et al. Neurosarcoidosis associated with hypersomnolence treated with corticosteroids and brain irradiation. Chest, 1988; 94:205–06.
76. ServanJ, MarchandF, GarmaL, et al. [Narcolepsy disclosing neurosarcoidosis]. Rev Neurol (Paris), 1995; 151:281–83.
77. BejarJ M, KerbyG R, ZieglerD K, et al. Treatment of central nervous system sarcoidosis with radiotherapy. Ann Neurol, 1985; 18:258–60.
78. IaboniA, IbanezD, GladmanD D, et al. Fatigue in systemic lupus erythematosus: contributions of disordered sleep, sleepiness, and depression. J Rheumatol, 2006; 33:2453–57.
79. Valencia-FloresM, ResendizM, CastanoV A, et al. Objective and subjective sleep disturbances in patients with systemic lupus erythematosus. Arthritis Rheum, 1999; 42:2189–93.
80. ChandrasekharaP K, JayachandranN V, RajasekharL, et al. The prevalence and associations of sleep disturbances in patients with systemic lupus erythematosus. Mod Rheumatol, 2009; 19:407–15.
81. AbadV C, SarinasP S, GuilleminaultC. Sleep and rheumatologic disorders. Sleep Med Rev, 2008; 12:211–28.
82. MalowB A, BowesR J, LinX. Predictors of sleepiness in epilepsy patients. Sleep, 1997; 20:1105–10.
83. PiperidouC, KarlovasitouA, TriantafyllouN, et al. Influence of sleep disturbance on quality of life of patients with epilepsy. Seizure, 2008; 17:588–94.
84. ManniR, TartaraA. Evaluation of sleepiness in epilepsy. Clin Neurophysiol, 2000; 111(Suppl 2):S111–14.
85. ManniR, RattiM T, SartoriI, et al. Sleepiness and its associated factors in epilepsy patients. Sleep [abstract], 1998; 21:175.
86. de WeerdA, de HaasS, OtteA, et al. Subjective sleep disturbance in patients with partial epilepsy: a questionnaire-based study on prevalence and impact on quality of life. Epilepsia, 2004; 45:1397–404.
87. KhatamiR, ZutterD, SiegelA, et al. Sleep–wake habits and disorders in a series of 100 adult epilepsy patients – a prospective study. Seizure, 2006; 15:299–306.
88. ManniR, PolitiniL, SartoriI, et al. Daytime sleepiness in epilepsy patients: evaluation by means of the Epworth sleepiness scale. J Neurol, 2000; 247:716–17.
89. ZucconiM, OldaniA, SmirneS, et al. The macrostructure and microstructure of sleep in patients with autosomal dominant nocturnal frontal lobe epilepsy. J Clin Neurophysiol, 2000; 17:77–86.
90. BazilC W, WalczakT S. Effects of sleep and sleep stage on epileptic and nonepileptic seizures. Epilepsia, 1997; 38:56–62.
91. VignatelliL, BisulliF, NaldiI, et al. Excessive daytime sleepiness and subjective sleep quality in patients with nocturnal frontal lobe epilepsy: a case-control study. Epilepsia, 2006; 47(Suppl 5):73–77.
92. Sanchez de LeonI F N, MarsilioD, DinnerD S. Effect of seizure frequency and antiepileptic drugs on daytime alertness as measured by the Epworth Sleepiness Scale in patients with epilepsy. Epilepsia [abstract], 1997; 38:56.
93. MagantiR, HausmanN, KoehnM, et al. Excessive daytime sleepiness and sleep complaints among children with epilepsy. Epilepsy Behav, 2006; 8:272–77.
94. ChihorekA M, Abou-KhalilB, MalowB A. Obstructive sleep apnea is associated with seizure occurrence in older adults with epilepsy. Neurology, 2007; 69:1823–27.
95. JenssenS, GracelyE, MahmoodT, et al. Subjective somnolence relates mainly to depression among patients in a tertiary care epilepsy center. Epilepsy Behav, 2006; 9:632–35.
96. ByarsA W, ByarsK C, JohnsonC S, et al. The relationship between sleep problems and neuropsychological functioning in children with first recognized seizures. Epilepsy Behav, 2008; 13:607–13.
97. EbbenM R, SethiN K, ConteM, et al. Vagus nerve stimulation, sleep apnea, and CPAP titration. J Clin Sleep Med, 2008; 4:471–73.
98. GschliesserV, HoglB, FrauscherB, et al. Mode of vagus nerve stimulation differentially affects sleep related breathing in patients with epilepsy. Seizure, 2009; 18:339–42.
99. MalowB A, EdwardsJ, MarzecM, et al. Vagus nerve stimulation reduces daytime sleepiness in epilepsy patients. Neurology, 2001; 57:879–84.
100. MacleodS, FerrieC, ZuberiS M. Symptoms of narcolepsy in children misinterpreted as epilepsy. Epileptic Disord, 2005; 7:13–17.
101. DauvilliersY, StalV, AbrilB, et al. Chiari malformation and sleep related breathing disorders. J Neurol Neurosurg Psychiatry, 2007; 78:1344–48.
102. NoguesM, CammarotaA, LeiguardaR, et al. Periodic limb movements in syringomyelia and syringobulbia. Mov Disord, 2000; 15:113–19.