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Subsequent reports by Williams [2] and Walsleben [3] passingly mentioned other sleep disorders, but failed to elaborate on somnambulism (in the lay term, sleepwalking).
In one of the anonymous early reports [4] that appeared on somnambulism in 1834, the recommendation offered for treating somnambulism was “
Nevertheless, medical knowledge on somnambulism, especially after the discovery of rapid eye movement (REM) sleep in 1953 [5] and the use of polysomnographic detection methods [6, 7], has accumulated in the past 65 years. Though it was widely believed until 1956, that somnambulism occurs during the dream phase (i.e., REM sleep stage), Jacobson et al. [8] demonstrated in nine subjects (seven men and two women, aged 9–23 years) that somnambulistic episodes occur during the N3 stage of slow-wave sleep (SWS) or non-rapid eye movement sleep (non-REM sleep). Specific electroencephalogram features of the N3 stage of SWS include delta waves (0.5–2 Hz, amplitude >75 μV) and slow oscillations (<1 Hz) [9]. For what is known about somnambulism until now, five reviews [9, 10, 11, 12, 13], with over 50 citations can be consulted profitably.
The objective of this chapter is to review recent developments on the presumed etiology, associated disorders, and treatment strategies currently available for somnambulism. The interdisciplinary relevance of somnambulism between medicine and law is also highlighted.
Somnambulism or sleepwalking is one of the 15 parasomnias among the 81 recognized major sleep disorders. It is characterized by sudden arousal occurring at the SWS stages, resulting in walking behavior during a state of altered consciousness [14]. Somnambulism prevalence of 1–6% was indicated by Kleitman [15], “depending on whether the survey applied to the general public, hospital patients or to limited to children with sleep abnormalities.” Thirty years later, Shapiro and Dement [16] offered a wider range (1–15%) of somnambulism prevalence, with children at the higher end of the range, relative to adults.
According to Kleitman [15], French physiologist Georges Henri Roger (1860–1946) had provided a good description of a typical sleepwalker, in his 1932 book
Hereditary factors in the prevalence of somnambulism were first recorded in a short note, appearing in
Among a sample of 60 Caucasian subjects with somnambulism disorder, distributed in three countries (France, Switzerland, and Germany), Lecendreux et al. [18] reported that compared to eight (13.3%) age-matched controls, 21 (35%) somnambulists were positive for DQB1 allele of HLA-DQB antigen, and claimed this finding as a first genetic maker for somnambulism. HLA stands for human leukocyte antigen. Subsequently, Licis et al. [19] studied a four-generation Caucasian family in the USA consisting of 22 members, among whom nine were somnambulists and 13 were unaffected. Genome-wide linkage analysis from gathered DNA samples revealed the following facts—(1) genetic locus for somnambulism is present at chromosome 20q12-q13.12; (2) sleepwalking may be transmitted as an autosomal dominant trait with reduced penetrance; (3) seven among the nine somnambulists were males; (4) adenosine deaminase gene (ADA) is the most likely candidate gene in the chromosome 20q12-q13.12 linkage interval due to its association with SWS during with somnambulism occurs.
Since 1956, polysomnographic studies in somnambulist patients have been conducted in the USA, Canada, and a few European countries [7, 8, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32]. A chronological compilation of significant polysomnographic studies is presented in Table 1. Two recognizable features revealed were, (1) Earlier studies, with two exceptions, did not have proper control groups; (2) Until 2015, the total number of somnambulist patients was less than 40. In the studies reported by Hurwitz et al. [21] and Oudiette et al. [28], the higher number of patients suffered from sleepwalking
Country | Year | Somnambulists | Controls | Reference | ||||
---|---|---|---|---|---|---|---|---|
Sample no. | Age (yr) | Sample no. | age (yr) | |||||
Range | Mean ± SD | Range | Mean ± SD | |||||
USA | 1956 | 34 | n.r1 | 60 | n.r1 | Pierce and Lipcon [7] | ||
USA | 1965 | 9 | 9–23 | Nil | — | Jacobson et al. [8] | ||
UK | 1990 | 5 | 28.4 ± 7.8 | 352 | 17–44 | Crisp et al. [20] | ||
USA | 1991 | 8 [SW]2 15 [SW + ST]3 | 18–51 | Nil | — | Hurwitz et al. [21] | ||
Germany | 1998 | 10 | 27.6 ± 3.4 | n.r1 | 27 ± 3.7 | Mayer et al. [22] | ||
France | 2000 | 3[SW]2 2[SW+ST]3 | 22–40 | 31.2 ± 2.2 | 11 | 32.1 ± 2.5 | Espa et al. [23] | |
Switzerland | 2000 | 1 | 16 | Nil | Bassetti et al. [24] | |||
Poland | 2005 | 1 | 26 | 1 | 16 | Szelenberger et al. [25] | ||
Italy | 2007 | 8 | 21–49 | 12 | 29.5 ± 8 | Oliviero et al. [26] | ||
Canada | 2008 | 30 | 16–47 | Nil | — | Zadra et al. [27] | ||
France | 2009 | 8 [SW]2 30 [SW + ST]3 | 11–72 | 25 | ‘Age-matched’ | Oudiette et al. [28] | ||
Switzerland | 2013 | 10 | 66 ± 11.6 | Nil | — | Di Fabio et al. [29] | ||
France | 2014 | 12 | 27.4 ± 8.4 | Nil | — | Perrault et al. [30] | ||
Czech Rep | 2015 | 52 | 19–63 | 20 | 20–57 | Buskova et al. [31] | ||
France | 2017 | 89[SW]2 80[SW without SS]4 9[SW with SS]5 | 29.2 ± 7.1 32.8 ± 10.4 32.5 ± 10.1 | 15 | ‘Age-matched’ | Dubessy et al. [32] |
Significant polysomnographic studies in somnambulist patients.
n.r = not reported, presumed to be in late teens to 20s, as the subjects were naval recruits and Electronics school students.
Patients suffered from sleepwalking only.
Patients suffered from both sleepwalking and sleep terror.
Patients suffered from sleepwalking without sexsomnia.
Patients suffered from sleepwalking and sexsomnia.
Among the specific environmental factors precipitating somnambulistic episodes in adults, prescription medication use [33], alcohol [34], emotional stress [35], sleep deprivation [27], and certain psychiatric trauma [36] have been suggested. As such, a multifactorial etiology for somnambulistic disorder deserves recognition.
Somnambulism-associated disorders/syndromes are presented in Table 2. These include alcoholism [34], brain tumor [37], bulimia [38, 39], epilepsy [40, 41, 42, 43], hyperthyroidism [44], migraine [45, 46, 47, 48], nocturnal hypoglycemia [49, 50], Parkinson’s disease [29, 51, 52], sexsomnia [32], sleep-disordered breathing [53, 54, 55], and Tourette’s syndrome [56, 57]. In a cross-sectional case–control study conducted in Montpellier, France, with 100 adult sleepwalkers (55 men and 45 women, aged 18–59 years), Lopez et al. [48] found 44% suffered from chronic pain, compared to 20% of controls. Those sleepwalkers with chronic pain were more likely to be older and had higher daytime sleepiness. As one of the limitations in this study, Lopez et al. [48] had noted that pain sensitivity was not measured. Di Fabio et al. [29] reported that 9% of their 417 Parkinson’s disease patients were somnambulists, and concluded that sleepwalking in Parkinson’s disease is associated with depression, higher disease severity, and higher functional disability.
Somnambulism-associated Disorders/Syndromes | References |
---|---|
Alcoholism | Himemiya-Hakucho and Fujimiya [34] |
Brain tumor | Prashad et al. [37] |
Bulimia | Guirguis [38] |
Bell and Tomkinson [39] | |
Epilepsy | Pierce and Lipcon [40] |
Tinuper et al. [41] | |
Cornejo-Sanchez et al. [42] | |
Duffau et al. [43] | |
Hyperthyroidism | Ajlouni et al. [44] |
Migraine | Barabas et al. [45] |
Giroud et al. [46] | |
Pradalier et al. [47] | |
Lopez et al. [48] | |
Nocturnal hypoglycaemia | Bell [49] |
Cebrian et al. [50] | |
Parkinson disease | Poryazova et al. [51] |
Di Fabio et al. [29] | |
Oberholzer et al. [52] | |
Sexsomnia | Dubessy et al. [32] |
Sleep-disordered breathing | Espa et al. [53] |
Guillaminault et al. [54] | |
Guillaminault et al. [55] | |
Tourette’s syndrome | Barabas et al. [56] |
Jimenez-Jimenez et al. [57] |
Somnambulism associated disorders/syndromes.
Compared to age and gender-matched control group, in 14 drug-free polysomnographically confirmed adult somnambulists (age range 21–39 years), an MRI study reported by Heidbreder et al. [58] showed significant decreases of gray matter in the left dorsal posterior cingulate cortex and posterior midcingulate cortex. The mean disease duration of adult somnambulists was reported as 19.2
No drug has been developed specifically to cure somnambulism [60]. However, based on case histories, clonazepam—a tranquilizer of benzodiazepine class patented in 1960, at 0.25–0.5 mg dose to be taken 1–2 h before sleeping [61, 62, 63], imipramine—a tricyclic antidepressant [64], paroxetine—a selective serotonin reuptake inhibitor [65] and ramelteon, a melatonin receptor agonist, at a dose of 4 mg/day [66] have been suggested for successful treatments. Though clonazepam has been the most widely used medication for non-REM sleep parasomnias with reported success, its use has been restricted in France, for the reason that it may increase sleep-disoriented breathing and induce sedation the following day [32].
In a recent review on medication-induced somnambulism, Stallman et al. [33] had identified 29 medications that are possible triggers for sleepwalking. For convenience, these medications have been categorized into five classes as follows—(1) benzodiazepine receptor agonists and other gamma-aminobutyric acid (GABA) modulators, (2) antidepressants and other serotonergic agents, (3) antipsychotics, (4) β-blockers, and (5) “others,” including antibiotic ciprofloxacin.
Other types of treatments include hypnosis [67, 68], psychotherapy, aversive behavioral therapy [69], and the use of customized bed alarms. A recent review with 60 references by de Cock [70] is recommended for additional details on this theme.
While studying the records of 20 patients admitted to intensive care units, who had a diagnosis of self-injurious sleep behavior disorders, between 1982 and 1990, at the Minnesota Regional Sleep Disorders Center, USA, Schenck and Mahowald [62] recognized that three among the 20 suffered from chronic night terrors/sleepwalking abnormality. The influence of various stressors commonly found in the intensive care units (such as sleeping in an unfamiliar setting, sleep disruption/deprivation, medication administration/withdrawal, and psychologic distress) may aggravate the condition of sleepwalkers is one inference from this study. From a retrospective chart review study of patients older than 15 years, admitted to the emergency department at a university hospital in Berne, Switzerland, Sauter et al. [71] inferred that life-threatening injuries associated with somnambulism may occur. As such, when patients present with falls of unknown origin, the possibility of somnambulistic cause should be considered. The 11 trauma patients, Sauter et al. [71] encountered, had injuries identified as contused facial lacerations, head injury, contusion of ribs, cervical spinal dislocation, and paraplegia below the thoracic vertebral body.
Self-caused injuries [71, 72] not-withstanding, to a confused public, somnambulism seems to be a puzzling phenomenon that flirts between the boundaries of medicine and the law. The pros and cons of the rights and penalties for this class of sleep disorder patients who commit serious crimes, including homicides [73], during somnambulistic episodes, continue to be debated without any resolution [74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84]. A controversial issue is the use of somnambulism defense in cases involving alcohol-induced homicides. In reviewing the scientific evidence and forensic considerations, Pressman et al. [85] had inferred that a defense of alcohol-induced sleepwalking or confusional arousal becomes a very attractive legal strategy with the potential of acquittal for the defendant. This, despite the fact “there is no direct experimental evidence that alcohol predisposes or triggers sleepwalking or related disorders.”
Quite a number of reports have appeared in the last three decades, implicating somnambulism with sexual misconduct as well [86, 87, 88]. Among the nine cases of sleep-related violence and nine cases of sexual behavior in sleep, published between 1980 and 2012, the sleepwalking defense was proposed in 11 among these 18 cases [89]. In their review of these 18 cases, Ingravallo et al. [89] indicated that the trial outcome was in favor of the defendant in 14 of 18 cases. As the forensic evaluations widely differed from case to case, they had concluded that “an international multidisciplinary consensus for the forensic evaluation of sleep-related violence and sexual behavior in sleep need to be developed as an urgent priority.” Though clinical descriptions of somnambulists with sexsomnia as anecdotal case reports show an increase in this century [32], probably due to its titillating factor in the digital mass media, it is not easy to replicate somnambulist-sexsomnia episodes in hospitalized setting, except on unusual conditions that such patients have a bed sharer of the same sex or opposite sex, during the observation period.
As somnambulism has not been recorded in non-human primates, no animal model exists to study somnambulism under controlled settings for elucidation of its biochemical mechanism of origin [90]. As such, the available pharmacological treatments have to be considered as the scatter-shot approach of case studies without appropriate controls [91]. Thus, partial or total alleviation of somnambulistic symptoms in children and adults deserves the attention of health researchers. Adequately powered, well-designed clinical trials remain the need of the moment. The plea made by Chinthapalli [92], an associate editor of the
I declare no conflict of interest.
I became interested in the somnambulism phenomenon while serving as a Visiting Professor at Kyoto University, Primate Research Institute, Inuyama (Japan) and studying the activity-sleep behavior of New World and Old World Monkeys, between 2002 and 2006. I appreciate the discussions I have had with veterinarians, Dr. Kiyoaki Matsubayashi and Dr. Juri Suzuki, during that period.
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\n\nEvery single Work that is used has to be attributed in the way described. If you are unsure about proper attribution, please write to permissions@intechopen.com.
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Biosensors, Biomaterials and Tissue Engineering",value:9,count:1},{group:"subseries",caption:"Bioinspired Technology and Biomechanics",value:8,count:2},{group:"subseries",caption:"Bioinformatics and Medical Informatics",value:7,count:9}],publicationYearFilters:[{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2019",value:2019,count:5},{group:"publicationYear",caption:"2018",value:2018,count:3}],authors:{paginationCount:228,paginationItems:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",biography:"Dr. Aneesa Moolla has extensive experience in the diverse fields of health care having previously worked in dental private practice, at the Red Cross Flying Doctors association, and in healthcare corporate settings. She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. 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Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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