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Results for “REM Sleep Behavior Disorder”

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PubMed2000

[Consideration on neuroimaging and functional diagnosis in cerebrovascular disorder].

The electroencephalogram(EEG) has been one of the important clinical examination in cerebrovascular disorder(CVD). Since X-ray computed tomography(CT) was introduced in the 1970's, the numbers of EEG examination decreased in Japan. In the present, the diagnosis of acute CVD is done by neuroimaging examinations which generally are CT, magnetic resonance imaging(MRI) and at times, single photon emission computed tomography(SPECT). But EEG examination is necessary for estimate of brain function in acute and/or chronic CVD. Only EEG examination is able to confirm epileptic seizure, sleep-wake disorder and disturbance of consciousness. alpha-coma and spindle coma are peculiar disturbance of consciousness and appear in acute CVD. REM sleep behavior disorder(RBD) sometimes appear in chronic CVD. The characteristic of RBD is violent or injurious behavior during REM sleep. Polysomnography demonstrates abnormal REM sleep without loss of atonia. Both neuroimaging and functional diagnosis have been to perform to estimate in CVD same as in the other central nervous disorders.

Cerebrovascular Disorders↗
PubMed2001

Parasomnia as an occasion for the diagnosis of Parkinson's disease.

We report a case of Parkinson's disease (PD) diagnosed by REM sleep behavior disorder (RBD). The patient was a 68-year-old man. On admission, rigidity in the left upper and lower extremities, bradykinesia, and gait disturbance were noted. In addition, polysomnography revealed REM sleep without atonia (RWA), and a diagnosis of untreated PD associated with RBD was made. Polysomnographic data showed that REM density decreased and RWA tended to increase after administration of a combination of L-DOPA and DCI (L-DOPA/DCI). Thus, we considered that the pathophysiological mechanism of RBD in this case was based not only on the dysfunction of the brainstem mechanism of RWA, but also on the impairment of dopaminergic neuron.

Aged↗
PubMed2004

DLB fluctuations: specific features that reliably differentiate DLB from AD and normal aging.

OBJECTIVE: To determine whether certain aspects of fluctuations reliably distinguish dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) and normal aging. METHODS: Participants included 200 community-dwelling cognitively normal elderly persons, 70 DLB patients, and 70 AD patients with collateral informants. A 19-item questionnaire was administered to the informants that queried about symptoms of fluctuations and delirium. RESULTS: Fluctuations occur infrequently in nondemented elderly persons aged 58 to 98 years. In contrast, four characteristics of fluctuations were found to significantly differentiate AD from DLB. These composite features include daytime drowsiness and lethargy, daytime sleep of 2 or more hours, staring into space for long periods, and episodes of disorganized speech. The presence of three or four features of this composite occurred in 63% of DLB patients compared with 12% of AD patients and 0.5% of normal elderly persons. Informant endorsement of three or four of these items yielded a positive predictive value of 83% for the clinical diagnosis of DLB against an alternate diagnosis of AD. Endorsement of fewer than three items had a negative predictive value of 70% for the absence of a clinical diagnosis of DLB in favor of AD. The authors present evidence of test-retest reliability, convergent validity, and empirical verification with a separate cross-validation sample. Fluctuations were not associated with any particular combination of hallucinations, parkinsonism, or REM sleep behavior disorder. CONCLUSIONS: Based on informant report, disturbed arousal and disorganized speech are specific aspects of fluctuations in dementia with Lewy bodies that reliably distinguish dementia with Lewy bodies from Alzheimer's disease and normal aging.

Aged↗
PubMedDate not supplied

[Parasomnia].

The parasomnias comprises a group of disorders that intrude into the sleep process and are not primarily disorders of sleep and wake states per se. These disorders are manifestations of central nervous system activation usually transmitted through skeletal muscle or autonomic nervous system channels (ICSD 1990). The parasomnias are divided into four groups: Arousal disorders (sleepwalking, night terrors, and confusionnal arousal), sleep-wake transition disorders (rhythmic movement disorder, sleep starts), REM sleep parasomnias (nightmares, sleep paralysis, hallucinations, and REM sleep behavior disorders), and other parasomnias (sleeptalking, nocturnal enuresis, and nocturnal bruxism.

Adult↗
PubMed2002

Rapid Eye Movement Sleep-related Parasomnias.

Among the rapid eye movement (REM) sleep-related parasomnias, the most common and important disorder for which patients present is REM sleep behavior disorder (RBD). Rapid eye movement sleep behavior disorder is often undiagnosed for many years, despite the sometimes bizarre and harmful behaviors involved. Complete evaluation and accurate diagnosis are essential for proper management. This includes medical, sleep/wake, psychiatric, and neurologic histories. Although they may raise feelings of guilt or shame, questions related to sexual and violent behaviors should be directed towards the identified patient as well as their bed partners. Objective studies should include nocturnal polysomnogram with audiovisual monitoring of behavior, electromyography (EMG) of all limbs, and seizure montage. Brain imaging, clinical electroencephalogram (EEG), neuropsychometric testing, and actigraphy may be used adjunctively. Clinicians should have a high index of suspicion for other neurologic conditions, especially neurodegenerative disorders and narcolepsy, because many patients with RBD have these conditions. Rapid eye movement sleep behavior disorder may actually precede symptoms and signs associated with other neurologic disorders, so close follow-up is recommended. Medications that may be causing or exacerbating RBD should be withdrawn, if possible. Clonazepam is very effective in reducing the symptoms of RBD. This treatment is generally well tolerated and may be used long-term. Discontinuation of clonazepam usually leads to relapse of symptoms. Safety-related issues should be discussed with patients and their families.

Journal Article↗
PubMed1992

Update on disorders of sleep and the sleep--wake cycle.

Wakefulness and sleep are antagonistic states competing for the domain of brain activity. Non-REM sleep and REM sleep are different states of being, sustained by activity in brainstem nuclei, hypothalamus, basal forebrain, and thalamus. Such complex phenomenology is subject to many alterations grouped in the new International Classification of Sleep Disorders. The insomnias are the result of interacting psychosocial, psychophysiologic, neurodevelopmental, and medical factors. Proper perspective of each factor provides the clinical strategies to approach medically the symptom-complex of insomnia. The most common cause of daytime hypersomnia is chronic sleep deprivation. Obstructive sleep apnea responds to nasal CPAP, but the failure rate approaches 30%. In intolerant patients BiPAP and surgical remedies should be considered. Motor and behavioral abnormalities of sleep may be linked to REM sleep as in the REM sleep behavior disorder. Paroxysmal nocturnal dystonia and nocturnal wanderings may be associated with epilepsy. Intrusions of one state of being (wakefulness, non-REM sleep, and REM sleep) into another result in mixed, poorly defined, or only partially developed states. Dissociation of states may be responsible for confusional arousals, hallucinations, and cateplexy. Senile degeneration of the suprachiasmatic nuclei may underlie the circadian rhythm changes in old age and the "sundown" syndrome in demented patients. Misalignment of the hypothalamic pacemaker causes dysregulation of sleep-related physiologic and behavioral variables. Exposure to bright light retrains the pacemaker in night-shift workers, transmeridian travelers, and in patients with seasonal affective syndrome. Benzodiazepine compounds are very effective hypnotics, but should be used sparingly in the elderly to avoid falls, memory lapses, and aggravation of a preexisting sleep apnea syndrome. Sleep laboratory evaluations are indicated in patients with hypersomnia, suspected sleep apnea syndrome, motor-behavioral disorders of sleep, and in many individuals complaining of insomnia.

Age Factors↗
PubMed2002

Incidence of RBD and hallucination in patients affected by Parkinson's disease: 8-year follow-up.

We describe the 8-years follow-up of 80 patients affected by idiopathic, L-dopa-responsive Parkinson's disease. All patients were evaluated at baseline and during the follow-up with visual evoked potential, P300 event related potentials and polysomnography. The patients and their relatives compiled sleep and hallucination questionnaires. Statistical analysis was performed to evaluate if visual abnormalities, abnormal P300 recordings or sleep disturbances were linked to the development and hallucinations. Our results show that abnormal vision and abnormal P300 did not correlate with the incidence of hallucinations. However, the presence of REM sleep behavioral disorder (RBD) was significantly related to the development of hallucinations,independently of age, gender or duration of disease but dependent on the amount of dopaminoagonist treatment.

Age Factors↗
PubMedDate not supplied

[Sleep disorders in multiple system atrophy].

Sleep disorders are so common in multiple system atrophy that they should be considered an integral part of the disease. Sleep fragmentation occurs in more than half of the patients, with sleep onset and sleep maintenance insomnia. Periodic leg movements of sleep are also common, although they are generally asymptomatic. REM sleep behavior disorder, a parasomnia in which the patient presents vigorous movements associated with intense dreaming dreaming during REM sleep, is detected polysomnographically in almost all the patients with variable severity. Nocturnal stridor is produced by obstruction on the glottis level. The cause of stridor is unknown but two alternative explanations have been proposed: paralysis of the muscles opening the vocal chords and excessive contraction of the muscles that close them. A combination of both, however, is the most likely explanation. Nocturnal stridor is associated with decreased survival and its treatment is based on continuous positive air pressure (CPAP) when it occurs only during sleep or tracheostomy when it worsens and becomes also diurnal.

Humans↗
PubMed2002

Paroxysmal events in sleep.

This review describes the wide spectrum of episodic phenomena that can occur during sleep. These phenomena include arousal disorders of nonrapid eye movement (NREM) sleep, rapid eye movement (REM) sleep behavior disorder, movement disorders, psychiatric disorders, and epileptic seizures. Each of these entities is discussed in detail, focusing on their clinical manifestations, diagnosis, and treatment. Essential historic elements that distinguish these events and the role of video-EEG-polysomnography in their differential diagnosis are emphasized.

Diagnosis, Differential↗
PubMed2000

Sleep-related injury in the elderly--an epidemiological study in Hong Kong.

OBJECTIVES: Sleep-related injury is a serious but under-recognized condition. We examined the occurrence of sleep-related injuries and REM sleep behavior disorder (RSBD) in a community sample of elderly in Hong Kong. DESIGN: A representative sample of elderly aged 70 years or above were interviewed with a screening question on the presence of sleep-related injuries. Those who answered affirmatively as well as a subsample of negative responders were interviewed by clinicians. Patients with suspected sleep disorders underwent physical and psychiatric assessment as well as sleep studies. SETTING: NA. PATIENTS OR PARTICIPANTS: NA. INTERVENTIONS: NA. RESULTS: In total, 1034 elderly were surveyed and 0.8% reported history of sleep-related injury. Four subjects were confirmed to have RSBD, giving an estimated prevalence of RSBD of 0.38% (95% CI=0.01 to 0.76%). One subject had suspected RSBD but refused investigations while 1 had history suggestive of transient RSBD but could not be confirmed by the sleep studies. The course of RSBD in these subjects was that of a waxing and waning course instead of a progressive deterioration as described in previous literature. Two patients had been hospitalized for sleep-related injury before but their sleep disorder was not recognized. CONCLUSIONS: We found that sleep-related injury and RSBD were not rare in the elderly but were frequently under-recognized. Our study calls for greater attention to elderly who had sustained injury during sleep.

Aged↗
PubMed1998

[Parasomnias linked to the REM phase].

INTRODUCTION: The different parasomnias normally associated to REM sleep and included in the International Classification of Sleep Disorders (ICSD-90), are described. Clinical characteristics allow to do diagnostic of all of them, but the ones that allow an exact differential diagnostic over other parasomnias and other types of behavioral alterations, are the data obtained in sleep laboratory, with different polisomnographic and synchronized videotape techniques. Special emphasis is made in REM sleep behavior disorder.

Humans↗
PubMed2005

Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium.

The dementia with Lewy bodies (DLB) Consortium has revised criteria for the clinical and pathologic diagnosis of DLB incorporating new information about the core clinical features and suggesting improved methods to assess them. REM sleep behavior disorder, severe neuroleptic sensitivity, and reduced striatal dopamine transporter activity on functional neuroimaging are given greater diagnostic weighting as features suggestive of a DLB diagnosis. The 1-year rule distinguishing between DLB and Parkinson disease with dementia may be difficult to apply in clinical settings and in such cases the term most appropriate to each individual patient should be used. Generic terms such as Lewy body (LB) disease are often helpful. The authors propose a new scheme for the pathologic assessment of LBs and Lewy neurites (LN) using alpha-synuclein immunohistochemistry and semiquantitative grading of lesion density, with the pattern of regional involvement being more important than total LB count. The new criteria take into account both Lewy-related and Alzheimer disease (AD)-type pathology to allocate a probability that these are associated with the clinical DLB syndrome. Finally, the authors suggest patient management guidelines including the need for accurate diagnosis, a target symptom approach, and use of appropriate outcome measures. There is limited evidence about specific interventions but available data suggest only a partial response of motor symptoms to levodopa: severe sensitivity to typical and atypical antipsychotics in approximately 50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors.

Brain↗
PubMed2005

Unusual nocturnal motor restlessness in a patient with spinocerebellar ataxia 3.

Video-polysomnographic monitoring of a female patient with spinocerebellar ataxia 3 (SCA-3) in whom rapid eye movement (REM) sleep behavior disorder was clinically suspected demonstrated recurrent episodes of unusual nocturnal motor restlessness occurring during non-REM sleep and severely disturbing both the patient and her bed partner's sleep. Even if nocturnal manifestations are common features of SCA-3 and increasingly recognized, such a case has never been reported before. We discuss this peculiar movement disorder as a particular manifestation of the wide spectrum of parasomnias occurring in such a rare neurodegenerative disease.

Adult↗
PubMed2000

Sleep and periodic leg movement patterns in drug-free patients with Parkinson's disease and multiple system atrophy.

STUDY OBJECTIVE: To assess and compare polygraphic sleep measures and periodic leg movement (PLM) patterns in untreated patients with mild to moderate Parkinson's disease (PD), multiple system atrophy (MSA) and healthy age-matched controls. DESIGN: Polysomnographic recordings of 2 consecutive nights were performed in 10 patients with PD (mean age 65 years, mean Hoehn and Yahr stage 2.2), 10 patients with MSA (mean age 61 years) and in a control group of 10 healthy subjects (mean age 64 years). All patients and controls were free of antiparkinsonian medication and other centrally active drugs for 2 weeks prior to polysomnography. SETTING: NA. PATIENTS OR PARTICIPANTS: NA. INTERVENTIONS: NA. RESULTS: Sleep measures for the second night showed a significantly lower total sleep time, sleep efficiency and sleep period time in PD and MSA patients compared to healthy controls. PLM-indices during sleep and wakefulness were significantly higher in PD, but not in MSA patients compared to controls. Five patients with PD and 7 patients with MSA, but no control subject, showed abnormal rapid eye movement (REM) sleep features (i.e., REM sleep without atonia or behavioral manifestations typical for REM sleep behavior disorder). CONCLUSIONS: Sleep disruption and increased motor activity during REM and non REM sleep are a frequent finding in PD and MSA. An increased PLM index in untreated PD patients may be due to a dopaminergic deficit and is probably not associated with dopaminergic treatment.

Aged↗
PubMed2005

[Violent behavior during sleep].

Cases of violent behavior during sleep have been reported in the literature. However, the incidence of violent behavior during sleep is not known. One epidemiological study showed that approximately 2% of the general population, predominantly males, presented violent behavior while asleep. In the present study, the authors describe clinical and medico-legal aspects involved in violent behavior investigation. Violent behavior refers to self-injury or injury to another during sleep. It happens most frequently following partial awakening in the context of arousal disorders (parasomnias). The most frequently diagnosed sleep disorders are REM behavior disorder and somnambulism. Violent behavior might be precipitated by stress, use of alcohol or drugs, sleep deprivation or fever.

Adult↗
PubMed2003

[Sleep disorders during synucleopathies and taupathies].

Dissociate states of rapid eye movement sleep (REM) are much more frequent in patients with synucleopathy than in patients with taupathy (except that REM sleep behavior disorder may affect one third of patients with supranuclear palsy), as are sleep onset REM periods, observed in patients with Parkinson's disease, multiple systemic atrophy and Lewy body disease. Recent evidences suggest that they may result from non dopaminergic lesions, including cholinergic neurons in the locus subcoeruleus and orexinergic neurons in the lateral hypothalamus.

Acetylcholine↗
PubMed2000

[Manifestations of abnormal behavior during REM sleep in all-night polysomnography in patients with Parkinson disease].

REM sleep behaviour disorder (RBD) is characterized by savage extremities movements and by vocalizations associated with vivid dreams in REM sleep and by insufficient muscle atonia in REM sleep. Videopolysomnography was performed in nine patients (six men and three women, average age 59.8, SD +/- 7.2 years) suffering from Parkinson's disease (PD). The insufficient muscle atonia was found in the records of four subjects. No behavioural symptoms of RBD were observed. The authors stress on the disposition to RBD in great number of patients with RBD and on the necessity to look for RBD by detailed disease history.

Female↗
PubMedDate not supplied

Atypical sexual behavior during sleep.

OBJECTIVE: This article reports a case series of atypical sexual behavior during sleep, which is often harmful to patients or bed partners. METHODS: Eleven subjects underwent clinical evaluation of complaints of sleep-related atypical sexual behavior. Complaints included violent masturbation, sexual assaults, and continuous (and loud) sexual vocalizations during sleep. One case was a medical-legal case. Sleep logs, clinical evaluations, sleep questionnaires, structured psychiatric interviews, polysomnography, actigraphy, home electroencephalographic monitoring during sleep, and clinical electroencephalographic monitoring while awake and asleep were used to determine clinical diagnoses. RESULTS: Atypical sexual behaviors during sleep were associated with feelings of guilt, shame, and depression. Because of these feelings, patients and bed partners often tolerated the abnormal behavior for long periods of time without seeking medical attention. The following pathologic sleep disorders were demonstrated on polysomnography: partial complex seizures, sleep-disordered breathing, stage 3 to 4 non-rapid eye movement (REM) sleep parasomnias, and REM sleep behavior disorder. These findings were concurrent with morning amnesia. CONCLUSIONS: The atypical behaviors were related to different syndromes despite the similarity of complaints from bed partners. In most cases the disturbing and often harmful symptoms were controlled when counseling was instituted and sleep disorders were treated. In some cases treatment of seizures or psychiatric disorders was also needed. Clonazepam with simultaneous psychotherapy was the most common successful treatment combination. The addition of antidepressant or antiepileptic medications was required in specific cases.

Adolescent↗