sodium-oxybate and Movement-Disorders

Patients with essential tremor, vocal tremor, torticollis, myoclonus-dystonia and posthypoxic myoclonus often benefit in a surprisingly rapid and robust manner from ingestion of a modest amount of alcohol (ethanol). Despite considerable investigation, the mechanism of ethanol's ability to produce this effect remains a mystery. In this paper, we review the pharmacology of ethanol and its analogue GHB (or sodium oxybate), summarize the published literature of alcohol-responsive hyperkinetic movement disorders, and demonstrate videos of patients we have treated over the last fifteen years with either an ethanol challenge or with chronic sodium oxybate therapy. We then propose a novel explanation for this phenomenon-namely, that ingestion of

Topics: Adjuvants, Anesthesia; Alcoholic Beverages; Animals; Behavior, Animal; Central Nervous System Depressants; Cerebellar Nuclei; Dystonic Disorders; Essential Tremor; Ethanol; Humans; Hypoxia, Brain; Movement Disorders; Myoclonus; Neural Pathways; Purkinje Cells; Sodium Oxybate; Torticollis; Voice Disorders

Many movement disorders, including tics, chorea, tremor, myoclonus and parkinsonism, may result from substance abuse. However, alcohol in particular is associated in a more complex manner with two specific movement disorders, essential tremor (ET) and myoclonus-dystonia (M-D). In this review we discuss the comorbidity of alcohol abuse in both ET and M-D, the ameliorative effects of alcohol in both diseases, and review the data evaluating alcohol abuse secondary to self-medication. We also discuss shared pathophysiologic mechanisms in the understanding of both of these disorders, as the elucidation of the mechanisms by which alcohol exerts its effects may lead to novel therapeutic approaches.

Topics: Adjuvants, Anesthesia; Alcohol Drinking; Brain; Comorbidity; Dystonic Disorders; Essential Tremor; Ethanol; Exons; gamma-Aminobutyric Acid; Humans; Movement Disorders; Myoclonus; Phenotype; Point Mutation; Self Medication; Sodium Oxybate

Topics: Adjuvants, Anesthesia; Age of Onset; Aphasia; Cataplexy; Diagnostic Errors; Electroencephalography; Humans; Male; Middle Aged; Modafinil; Movement Disorders; Sodium Oxybate; Stroke; Wakefulness-Promoting Agents

Periodic leg movements during sleep (PMS) is a disorder frequently encountered in narcolepsy. In the present study, 12 narcoleptic patients (six with PMS and six without) were recorded in a sleep laboratory for 2 consecutive nights before and after treatment with gamma-hydroxybutyrate (GHB) taken at bedtime for 1 month. Treatment resulted in decreased rapid eye movement (REM) sleep latency and increased REM efficiency without change in the total duration of REM sleep. GHB was associated with the appearance of pathological levels of PMS in patients who were unaffected before treatment. These results are discussed in relation to the role of dopamine in the physiopathology of narcolepsy and PMS.

Topics: Adult; Humans; Hydroxybutyrates; Leg; Middle Aged; Movement; Movement Disorders; Narcolepsy; Sleep, REM; Sodium Oxybate

Seven patients suffering from restless legs syndrome (RLS) and periodic movements in sleep (PMS) were investigated before and after treatment with L-Dopa. The effect of treatment was evaluated by polysomnography, structured interviews, and daily questionnaires. Sleep organization and subjective complaints improved during treatment with 100 to 200 mg of L-Dopa. Polysomnographic recordings also revealed a significant decrease of periodic leg movements during the first third of the night and a rebound during the last third. These results and previous biochemical findings raise the hypothesis that RLS and PMS may both result from reduced dopaminergic activity in the CNS, perhaps resulting from decreased sensibility of postsynaptic receptors.

Topics: Adult; Central Nervous System; Dopamine; Female; Humans; Levodopa; Male; Movement Disorders; Restless Legs Syndrome; Sleep Wake Disorders; Sodium Oxybate; Synaptic Transmission

Topics: Administration, Oral; Humans; Hydroxybutyrates; Injections, Intravenous; Movement Disorders; Narcolepsy; Sodium Oxybate