Clinical Personalized Medicine for Parkinson's Disease and Implications on Sleep Dysfunction.

Personalized medicine (PM) for Parkinson's disease (PD) can range from precision genomic therapies such as ambroxol in glucocerebrosidase mutation-linked PD to treatment tailored for sleep dysfunction in nonmotor subtypes of PD. Additionally, in future pharmacogenetics may also play a part by identification of PD patients susceptible to specific sleep problems such as sudden onset of sleep and facilitate avoiding drugs that may cause these side effects. Age, physical exercise, comorbidities can also drive quality of sleep in PD and form important part of the Parkinson's dashboard-led strand of PM.

Transdermal, Infusion, and Surgical Therapies and Effect on Sleep Dysfunction in Parkinson's Disease.

Sleep dysfunction is dominant in patients on oral dopamine replacement therapies as nighttime therapy is suboptimal and often not attempted. Non oral infusion-based Parkinson's disease (PD) therapies, transdermal therapies, as well as deep brain stimulation (DBS) of the subthalamic nucleus (STN) bridge this gap and provide nighttime cover in most cases in PD. DBS of the STN also show significant improvement in PD sleep scale scores and improvement in sleep quality.

Pharmacological Management of Insomnia in Parkinson's Disease.

Sleep dysfunction can affect almost 90% of Parkinson's disease (PD) patients and insomnia related to fragmented sleep is common. Satisfactory management remains an unmet need although dopaminergic non-oral treatments utilising a continuous drug delivery strategy appears to help sleep maintenance insomnia. Transdermal therapy with rotigotine or subcutaneous apomorphine infusion is effective while recent data show considerable efficacy of intrajejunal or subcutaneous levodopa infusion on alleviation of insomnia in PD.

Early Onset Parkinson's Disease and Sleep Dysfunction.

Sleep dysfunction is a significant component of the non-motor symptom profile in Parkinson's disease (PD). Patients with early onset PD (EOPD) are a unique challenge and may present with specific patterns of sleep disturbances, which tend to be related to the underlying genetic causes. Furthermore, owing to the younger age of patients with EOPD, sleep disturbances significantly impact multiple domains including employment, ability to drive, social interactions, caregiver burden, and so forth.

Non-motor Subtypes of Parkinson's Disease and Sleep Dysfunction.

Parkinson's disease is a syndrome with many clinical presentations. It is often dominated by visible motor symptoms; however, specific nonmotor features, such as cognitive dysfunction, sleep dysfunction, pain, apathy, dysautonomia, depression, and anxiety, enrich the clinical picture significantly. Proposed non-motor phenotypes segregate to central cholinergic, serotonergic, or noradrenergic dysfunctions, and clinical and biomarker-driven studies support these subtypes.