Parkinson's disease is the second most common neurodegenerative disease and, according to current estimates, affects more than 400.000 people in Germany. The cause is a misfolded protein called alpha-synuclein, which clumps together and builds up in the brain. This causes nerve cells to die. The typical symptoms such as slowed movements, muscle stiffness or tremors usually only appear many years later, when the brain has already been irreversibly damaged. But there are also reliable harbingers that indicate impending Parkinson's disease long before it becomes noticeable through motor deficits. This includes a typical behavioral disorder in the REM sleep phase, in which most dreams also take place. Researchers at the Department of Neurology with Clinical Neurophysiology at the Hannover Medical School (MHH) now want to build a study cohort of those affected with REM sleep behavior disorder in order to better research the preliminary phase of Parkinson's disease and to develop new biomarkers for early diagnosis Therapy a DAK Bungalow.
Sleep disturbance as a sure sign of Parkinson's risk
The REM sleep phase is characterized, among other things, by rapid eye movements (rapid eye movement, REM) with the lids closed. In healthy people, the skeletal muscles are relaxed during this phase. People with REM sleep behavior disorder (RBD), on the other hand, show muscle activity ranging from mild twitches to vigorous whole-body movements, often combined with screaming or vocalizations. "If there are no other causes, such as drug use or taking certain medications, 80 to 90 percent of those affected will develop Parkinson's or a Parkinson's-like disease within the next ten years," says senior physician Dr. Martin Klietz. This means that the disorder is currently the most reliable clinical sign of an existing risk of Parkinson's disease - and a good starting point for successful treatment.
Diagnostics using mobile sleep monitoring
"At this early point in time, not that many nerve cells have been destroyed," explains the neurologist. “So far, therapies have only started when the patients show motor abnormalities. But then at least half of the nerve cells in the brain have already perished.” Clinical studies with patients at this stage were therefore unsuccessful. Together with his colleague senior physician Dr. Matthias Höllerhage, the doctor would now like to pursue a different approach and identify those affected in the preliminary phase. To do this, the neurologists invite patients with a possible REM sleep behavior disorder to a telephone interview and first record their data and medical history. In the next step, they check whether the individual case is actually RBD. This is done by monitoring sleep using video polysomnography. During sleep, brain currents and muscle tension are recorded via electrodes and the oxygen content of the blood and air flow are also measured. Image and sound recordings also document whether the patients are snoring, speaking or moving. Because the measuring device can be used on the go, the participants do not have to spend the night in the clinic to monitor their sleep.
Saving nerve cells from destruction
If the signs point to RBD, further examinations should support the suspicion of a preliminary phase of Parkinson's disease. This is done by MRI imaging of the head and by examining the cerebrospinal fluid for deposits of the misfolded protein alpha-synuclein. In addition to being informed about their state of health, the test persons also benefit directly from the expertise of the clinic. "We are the only center for Parkinson's disease in the region with a proven focus on the care of patients in all stages of the disease and will continue to support the participants," emphasizes the neurologist. As part of the study, the researchers want to examine blood samples for possible biomarkers and collect the data and the biomaterial in a biobank. "With our research, we want to get to the point where we know how to save the nerve cells," notes Dr. Höllerhagen festival. In the long term, the neurologists then want to examine therapy options in clinical studies in order to treat patients in the preliminary phase of Parkinson's neuroprotectively and to protect the nerve cells in the brain from destruction. "The goal is that Parkinson's can be stopped in the future before the brain suffers massive damage," explains Dr. Klietz.
Participants wanted
The Clinic for Neurology with Clinical Neurophysiology still offers places to participate in the study. Patients who take part in the project benefit, for example, from the fact that they receive comprehensive diagnostics and care from professional staff throughout their participation. Interested parties can obtain further information about the study and the conditions for participation via the e-mail address RBD@mh-hannover.de.
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For more information, contact Dr. Martin Klietz, klietz.martin@mh-hannover.de.
