Journal of Neurology

, Volume 256, Issue 7, pp 1174–1176 | Cite as

Rapid-eye-movement sleep behavior disorder secondary to acute aseptic limbic encephalitis

  • Feng-Cheng Lin
  • Ching-Kuan Liu
  • Chung-Yao Hsu
Letter to the Editor


Rapid-eye-movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by complex motor activity associated with dreaming during REM sleep. RBD may be idiopathic or associated with various neurological diseases involving the brainstem. The association of RBD and limbic system impairment was unclear. We report a 46-year-old man with acute aseptic limbic encephalitis in association with RBD. The patient presented with subacute onset of anterograde/retrograde amnesia and persistent fever. Abnormal nocturnal behavior during sleep consisted of waving hands to fight and kicking legs. Brain magnetic resonance imaging showed damage on the bilateral unci and medial temporal lobes. Cerebrospinal fluid analysis indicated aseptic encephalitis. A polysomnography revealed augmented phasic activity in the submental and bilateral tibialis anterior muscles during REM sleep. Our finding suggests that limbic system impairment may lead to the occurrence of RBD.


Aseptic encephalitis Limbic system REM sleep behavior disorder (RBD) 


  1. 1.
    Olson EJ, Boeve BF, Silber MH (2000) Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 123:331–339PubMedCrossRefGoogle Scholar
  2. 2.
    Schenck CH, Mahowald MW (2002) REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep 25:120–138PubMedGoogle Scholar
  3. 3.
    Iranzo A, Graus F, Clover L, Morera J, Bruna J, Vilar C, Martinez-Rodriguez JE, Vincent A, Santamaria J (2006) Rapid eye movement sleep behavior disorder and potassium channel antibody-associated limbic encephalitis. Ann Neurol 59:178–181PubMedCrossRefGoogle Scholar
  4. 4.
    Kennedy PG (2004) Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry 75:i10–i15PubMedCrossRefGoogle Scholar
  5. 5.
    Iranzo A, Molinuevo JL, Santamaria J, Serradell M, Marti MJ, Valldeoriola F, Tolosa E (2006) Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 5:572–577PubMedCrossRefGoogle Scholar
  6. 6.
    Hickey MG, Demaerschalk BM, Caselli RJ, Parish JM, Wingerchuk DM (2007) “Idiopathic” rapid-eye-movement (REM) sleep behavior disorder is associated with future development of neurodegenerative diseases. Neurologist 13:98–101PubMedCrossRefGoogle Scholar
  7. 7.
    Thomas A, Bonanni L, Onofrj M (2007) Symptomatic REM sleep behaviour disorder. Neurol Sci 28:S21–S36CrossRefGoogle Scholar
  8. 8.
    Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, Benarroch EE, Ahlskog JE, Smith GE, Caselli RC, Tippman-Peikert M, Olson EJ, Lin SC, Young T, Wszolek Z, Schenck CH, Mahowald MW, Castillo PR, Del Tredici K, Braak H (2007) Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 130:2770–2788PubMedCrossRefGoogle Scholar
  9. 9.
    Compta Y, Iranzo A, Santamaria J, Casamitjana R, Graus F (2007) REM sleep behavior disorder and narcoleptic features in anti-Ma2-associated encephalitis. Sleep 30:767–769PubMedGoogle Scholar
  10. 10.
    Maquet P, Peters J, Aerts J, Delfiore G, Degueldre C, Luxen A, Franck G (1996) Functional neuroanatomy of human rapid-eye-movement sleep and dreaming. Nature 383:163–166PubMedCrossRefGoogle Scholar
  11. 11.
    Maquet P (2000) Functional neuroimaging of normal human sleep by positron emission tomography. J Sleep Res 9:207–231PubMedCrossRefGoogle Scholar
  12. 12.
    Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J (2000) Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain 123:1481–1494PubMedCrossRefGoogle Scholar
  13. 13.
    Tuzun E, Dalmau J (2007) Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist 13:261–271PubMedCrossRefGoogle Scholar
  14. 14.
    Vincent A, Buckley C, Schott JM, Baker I, Dewar BK, Detert N, Clover L, Parkinson A, Bien CG, Omer S, Lang B, Rossor MN, Palace J (2004) Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain 127:701–712PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of NeurologyKaohsiung Medical University HospitalKaohsiungTaiwan

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