Nocturnal symptom complex in PD and its management

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Abstract
In PD, degeneration of dopaminergic neurons in the CNS affects central sleep regulatory centers. Midbrain dopamine neurons have extensive connections with the striatum and also directly with the thalamus.10 These neurons are believed to modulate thalamocortical neuronal excitability which, in turn, influences the sleep–wake cycle (figure 1). 2 In a primate model, systemic administration of 1-methyl,4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), a dopamine neurotoxin, produced general and daytime sleepiness.11 The sleep-wake cycle also appears to be controlled by glutamatergic influences exerted on the basal ganglia circuitry from the subthalamic nucleus (STN), the pedunculopontine nucleus, and the laterodorsal tegmental nuclei.12-14 ⇓ ⇓ Various other neuropeptides/chemicals that modulate wakefulness and rapid eye movement (REM) sleep include serotonin, norepinephrine, histamine, acetylcholine, …