14. Old problems, new diseases

Alex Iranzo.
Barcelona, Spain


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Old problems, new diseases

Common sleep complaints include insomnia, hypersomnia, snoring, changes in the wake-sleep pattern and abnormal behaviors during sleep. Abnormal behaviors during sleep may be simple or complex and usually correspond to well-defined conditions such as hypnic jerks, sleepwalking, night terrors, periodic leg movements in sleep and seizures. Recent evidence indicates that abnormal sleep behaviors can be the first manifestation of two neurological diseases, namely Parkinson disease and anti-igLON5 disease.

REM sleep behavior disorder is a parasomnia first formally described in 1986 that is characterized by dream-enacting behaviors (e.g., punching, gesturing, kicking, crying, shouting), nightmares and loss of muscle atonia in REM sleep. Follow-up of individuals with the idiopathic form of REM sleep behavior disorder shows that most of them eventually develop the classical signs and symptoms of Parkinson disease.

The anti-igLON5 disease was first described in 2014 by physicians from Hospital Clinic de Barcelona. Patients with this condition report abnormal complex sleep behaviors such as talking, gesturing and manipulating imaginary objects that occur during both REM and nonREM sleep. Besides, these patients display other neurological symptoms (e.g., gait problems, cognitive dysfunction) and sleep problems (obstructive sleep apnea, stridor, abnormal sleep architecture). The disease is mediated by antibodies against the neuronal cell surface protein igLON5, a tight HLA association, and the presence of neuronal loss and tau deposits in the hypothalamus and brainstem.


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Alex Iranzo, MD, PhD, graduated in Medicine (1991) and defended his PhD thesis (2002) at the Universidad de Barcelona, Spain. Presently, he is neurologist Consultant 2 of the Neurology Service, Research Coordinator of the Neuroscience Institute and Coordinator of the Multidisciplinary Sleep Unit at the Hospital Clinic of Barcelona, Barcelona, Spain.

He is associate Professor of the University of Barcelona of Medicine, and investigator of August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and CIBERNED. He is Clinical Coordinator of AdSalutem Center of Sleep Medicine. He is President of the Spanish Sleep Society.

He is a member of numerous national and international societies such as the American Academy of Neurology, Movement Disorder Society, American Academy of Sleep, World Association of Sleep Medicine, European Sleep Society, International REM Sleep Behavior Disorder Group, European Restless Legs Syndrome Society, European Narcolepsy Network, Spanish Society of Neurology and Spanish Sleep Society.

Dr. Iranzo has widely published as first and corresponding author in peer reviewed journals such as The Lancet, The Lancet Neurology, Annals of Neurology, Neurology, Journal of Neurology Neurosurgery and Psychiatry, Movement Disorders, Sleep, and Sleep Medicine. Presently, he is at the editorial board of the journal Sleep Medicine.

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