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Journal of Neurology, Neurosurgery, and Psychiatry 1987;50:635-643 Department of Neurology, the H6pital Neurologique, Lyon since its
Middlesex Hospital, inauguration in 1965. We found 28 patients. Mortimer Street, Short REM sleep latency was recorded by London WI N 8AA, UK 24-hour polysomnography at least once in Cigarette smoking, Parkinson's disease and 24 patients. The other four patients had typulcerative colitis References ical narcolepsy-cataplexy attacks. 50 HLAA, B and C, 12 HLA-DR and 2 HLA-DQ Sir: Individuals who develop Parkinson's and study of smoking Dorn HA. The I Kahn serologically defined antigens were studied disease are about twice as likely to have been mortality among US veterans. Report on in every patient as previously described.4 habitual non-smokers when compared with and one half years of observations. In eigh. Smoking also a control population.`1 Epidemiological Approaches to the Study of Typing for HLA-DW2 and its subsets was seems to exert considerable protective effects Cancer and other Chronic Diseases. Mono- also performed as reported. 5 Results were against ulcerative colitis.46 It has been graph No. 19. Washington DC, National compared with a control population of CauCancer Institute. US Govt. Printing Office casian blood donors. Chi-square test was suggested that both these illnesses may be 1966: 1-125. used with a correction of probability values associated with inflexible, morose, inward2 Kessler II, Diamond KL. Epidemiological according to the number of HLA antigens looking personalities.7" One of us was studies of Parkinson's disease. 1. Smoking studied. The level of significance was chosen struck by what was possibly an unand Parkinson's disease. Am J Epidemiol at p < 0 05. recognised association between these two 197 1;94: 16-25. conditions, five patients with both illnesses Increases in the proportions of cases with 3 Godwin-Austen RB, Lee PN, Marmot MG, coming to light over a three year period. Stern GM. Smoking and Parkinson's disease. HLA-DQWI (100%), DR2 (92 9%), DW2 With the help of a letter expressing interest J Neurol Neurosurg Psychiatry' 1982;45: (92-9%) and B7 (50%) antigens were the 577-81. in this link which was published in the UK only significant observed differences when 4 Jick H, Walker AM. Cigarette smoking and narcoleptic patients were compared with Parkinson's Disease Society Newsletter and N Med 1983; Engl J ulcerative colitis. further postal questionnaires and correcontrols (table). The 26 DR2 positive nar308:261-3. spondence with the patients' general praccoleptic patients were all DR2 long/ Edmond Somerville KW, 5 M, RFA, Logan titioners, 20 more people with both diseases Langman MJS. Smoking and ulcerative col- DQWI/DW2. were found. The mean age of all 25 patients itis. Br Med J 1984;288:751-3. Two patients were DR2/DW2 negative. (14 men, 11 women) was 62 years (range 6 Vessey M, Jewell D, Smith A, Yeates D, The first one was a Caucasian 54 year old 43-79); six were in social class 1, eight in McPherson K. Chronic inflammatory bowel female phone operator with A2 A30/B7 disease, cigarette smoking and use of oral BW62/CW3/DRWI3 DRW14/DQWI antisocial class 2, six in social class 3, four in contraceptives: findings in a large cohort gens. Typical sleep attacks began at age 15 social class 4 and one in social class 5. In 19 study of women of childbearing age. Br Med the ulcerative colitis preceded the Parkinyears, up to 5 times per day. They were corJ 1986;292:1 101-3. son's disease, sometimes by many years. rected initially with 75 mg desipramine. The 7 M. Obsessional scores and Bellini Tansella M, Twenty of the patients had never smoked subjective general psychiatric complaints of drug was stopped owing to dizziness and tobacco, three had given up 25, 21 and 10 patients with duodenal ulcer or ulcerative replaced by 100 mg clomipramine with good years ago respectively; one was a very occolitis. Psychol Med 1976;6:461-7. efficacy and tolerance. Excessive daytime casional pipe smoker and the other patient 8 Todes CJ, Lees AJ. The pre-marked person- somnolence was another salient feature. ality of patients with Parkinson's disease. J Nocturnal sleep was self-estimated as excelhad smoked ten cigarettes a day all his life. Neurol Neurosurg Psychiatry 1985;48: lent and, usually, 10 hours long. However, The prevalence of non-smoking for an 97-100. age-sex-social class matched population in 9 Office of Population Censuses and Surveys. there was a transient fatigue on awakening. the United Kingdom would be about 50%.9 General Household Survey: cigarette smoking No actual cataplexy attacks, sleep paralysis Two of the ex-smokers in the study had 1972-1982. Govt. Statistical Service. GHC and hypnagogic hallucinations were experistopped smoking at least ten years before enced. A 24-hour polygraphic recording was 83/2 July 1983. or Parkinson's disease the onset of their made in February 1986 after a 2 weeks cesulcerative colitis; another smoked a pipe sation of drugs. It showed four sleep epivery occasionally. Eighty per cent of the sodes with direct REM sleep. Total sleep patients had never smoked tobacco and only Accepted 6 September 1986 duration was 12 h 30 min with a relative at at all tobacco were three (12%) smoking excess of REM sleep (43%). Otherwise, the time of onset of one or other disease. In since puberty, there were typical symptoms these the quantity smoked was fairly small and signs of dystrophia myotonica (Stei(15 cigarettes/day, 10 cigarettes/day and '/2 nert's disease) with myotonic discharges in oz (14 g) tobacco/week). Although derived the EMG. At the last examination in August from a highly selected cohort, these figures HLA-DR2 negative narcolepsy 1986, our patient was still minimally affected would be in keeping with the reported negaby the muscle disorder in her daily activity. tive association between smoking and both Sir: Association between narcolepsy and She had no respiratory insufficiency. A ulcerative colitis and Parkinson's disease. HLA-DR2 antigen is the strongest so far brother had both narcolepsy and Steinert's Further prospective epidemiological studies described between an HLA antigen and a disease. He died from myocardial infarction should examine the possible link between disease.`3 Among 28 narcoleptic patients, at age 44. Two sisters were operated on for these two diseases further and in particular we found two HLA-DR2 negative cases. We bilateral cataracts in their fourth decade. A the tantalising notion of a shared distinctive present their case-reports and discuss the brother and a sister were unaffected. We pre-morbid personality. were aware of one case of muscle disorder, implications of these data. K BIHARI We consulted the files of the patients two cases of early cataracts and one case of AJ LEES suffering from narcolepsy and referred to early baldness in the paternal lineage.
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