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Emmanuel During, MD, is a psychiatrist and neurologist with board certification in sleep medicine, Clinical Associate Professor at Stanford University in the Department of Psychiatry – Division of Sleep Medicine, and Department of Neurology. He directs the Stanford Parasomnia Clinic where he evaluates the broad spectrum of parasomnias, including REM sleep behavior disorder (RBD, abnormal dream-enactment) and other parasomnias such as sleepwalking, sleep talking, sleep terrors and confusional arousals. Lying at the interface of psychiatry, neurology and sleep, the Parasomnia Clinic functions as a platform for high-level specialized clinical care and direct enrollment into clinical trials, particularly for patients with RBD, which in a number of cases is an early sign of neurodegeneration such as Parkinson's disease or dementia with Lewy bodies. Dr. During is receiving federal and industry grant support for conducting research on RBD. He is currently the PI of an investigator-initiated sponsored trial investigating a new drug in treatment-refractory RBD (NCT04006925), and serves as site PI for a NIA grant supporting a nation-wide consortium, the North American Prodromal Synucleinopathy Consortium (NAPS), laying the groundwork for a first neuroprotective trial in the pre-Parkinson's stage of RBD, (NCT03623672). In 2018, he was invited to join a task force group of experts in RBD commissioned by the American Academy of Sleep Medicine (AASM) to issue the upcoming 2022 Clinical Guidelines for the management of RBD. He was invited the same year to join the International RBD Study Group (IRBD-SG), a group of world-experts in RBD ranging from clinicians to basic scientists. His most recent research interest pertains to wearable sleep devices that can potentially monitor RBD activity in patients home environment and facilitate early diagnosis.
Improving diagnostics and therapeutics in RBD, using home ambulatory devices including wearable actigraphy, dry-EEG, to power clinical trials based on objective outcomes of RBD activity.Controlling symptoms of RBD testing drugs rigorously.Predicting the course of neurodegeneration using deep phenotyping using clinical and serum biomarkers, measures of autonomic impairment, skin biopsy, microbiome
SAR231893-LPS15497- "Dupilumab Effect on Sleep in AD Patients"
To evaluate the effect of dupilumab on sleep quality in adult participants with moderate to
severe atopic dermatitis (AD).
To evaluate the effect of dupilumab on objective and subjective quantitative sleep
parameters, AD related outcomes, and daytime consequences of sleep deprivation.
To continue to assess the safety and tolerability throughout the study.
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Treatment of REM Sleep Behavior Disorder (RBD) With Sodium Oxybate
This study is the first clinical trial using sodium oxybate for the treatment of REM sleep
behavior disorder (RBD). Sodium oxybate is a drug approved by FDA for the treatment of
narcolepsy which has been used "off label" to treat patients with severe RBD. This drug has
shown to be effective and well tolerated in patients with RBD (Shneerson, 2009; Liebenthal,
2016; Moghadam, 2017).
Stanford is currently not accepting patients for this trial.
For more information, please contact Emmanuel During, 650-721-7561.
Natural History Study of Synucleinopathies
Synucleinopathies are a group of rare diseases associated with worsening neurological
deficits and the abnormal accumulation of the protein α-synuclein in the nervous system.
Onset is usually in late adulthood at age 50 or older. Usually, synucleinopathies present
clinically with slowness of movement, coordination difficulties or mild cognitive impairment.
Development of these features indicates that abnormal alpha-synuclein deposits have destroyed
key areas of the brain involved in the control of movement or cognition. Patients with
synucleinopathies and signs of CNS-deficits are frequently diagnosed with Parkinson disease
(PD), dementia with Lewy bodies (DLB) or multiple system atrophy (MSA).
However, accumulation of alpha-synuclein and death of nerve cells can also begin outside the
brain in the autonomic nerves. In such cases, syncucleinopathies present first with symptoms
of autonomic impairment (unexplained constipation, urinary difficulties, and sexual
dysfunction). In rare cases, hypotension on standing (a disorder known as orthostatic
hypotension) may be the only clinical finding. This "pre-motor" autonomic stage suggests that
the disease process may not yet have spread to the brain.
After a variable period of time, but usually within 5-years, most patients with abnormally
low blood pressure on standing develop cognitive or motor abnormalities. This stepwise
evolution indicates that the disease spreads from the body to the brain. Another indication
of this spread is that acting out dreams (i.e., REM sleep behavior disorder, RBD) a problem
that occurs when the lower part of the brain is affected, may also be the first noticeable
sign of Parkinson disease.
The purpose of this study is to document the clinical features and biological markers of
patients with synucleinopathies and better understand how these disorders evolve over time.
The study will involve following patients diagnosed with a synucleinopathy (PD/DLB and MSA)
and those believed to be in the "pre-motor" stage (with isolated autonomic impairment and/or
RBD). Through a careful series of follow-up visits to participating Centers, we will focus on
finding biological clues that predict which patients will develop motor/cognitive problems
and which ones have the resilience to keep the disease at bay preventing spread to the brain.
We will also define the natural history of MSA - the most aggressive of the
Once-Nightly Sodium Oxybate for Treatment of Excessive Daytime Sleepiness and Cataplexy in Narcolepsy
The purpose of this study is to determine whether once-nightly FT218 is safe and effective
for the treatment of excessive daytime sleepiness and cataplexy in subjects with narcolepsy.
North American Prodromal Synucleinopathy Consortium
This study will enroll participants with idiopathic rapid eye movement (REM) sleep behavior
disorder (RBD), for the purpose of preparing for a clinical trial of neuroprotective
treatments against synucleinopathies.