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ICPD: “Sleep Attacks” May Occur In Parkinson’s Patients Taking Dopaminergic Agents By Richard Robinson Special to DG News HELSINKI, FINLAND -- July 31, 2001 -- Sudden, irresistible onset of sleep-known as "sleep attacks"-can occur in Parkinson's patients who are being treated with any of the dopamine agonists or levodopa. These attacks, which have led to automobile accidents and several deaths in patients with Parkinson's disease (PD), have been the source of much controversy since their first description in 1999, according to Nik Homann, MD. Dr. Homann, from Karl Franzens University in Graz, Austria, performed a meta-analysis of all published sleep attack reports. He presented the results of his study, titled, "Sleep events with dopamine agonists: Fact and fiction", today (July 31) at the 14th International Congress on Parkinson’s Disease in Helsinki, Finland. Sleep attacks were first described in eight patients on the newest dopamine agonists-ropinirole and pramipexole-and immediately led both to more reports and to disputes about their existence in patients who were not already excessively sleepy. However, Dr. Homann reported that several investigators, including himself, have witnessed the onset of these attacks personally. In his case, he witnessed two patients whose sleep onset was half an hour after a single dose of apomorphine, who showed rapid and profound sleep onset, followed by unresponsiveness to pain or movement, and retrograde amnesia upon awakening. "This [type of sleep onset] is not the same as the gradual onset of sleep in over-tired patients," Dr. Homann said. His meta-analysis showed that sleep attacks have been reported in 123 patients. There were more men than women, and patients ranged from ages 34 to 87 years, with onset as early as one year after diagnosis. All dopamine agonists were implicated in these attacks, as well as levodopa, he said. While the attacks were more common with the newer agonists, Dr. Homann noted this was more likely to be due to the higher prescription rate for these drugs than any special properties they might possess. While dose reduction can mitigate the frequency of sleep attacks, Dr. Homann said this is often impractical, since this can lead to motor disability. "We're still looking for something to offer these patients," he said, but suggested modafinil may be useful in some patients. E-mail this page to a friend or colleague! To print, use this version