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Clinical Vignettes: Illustrative, Unusual, and Challenging RBD Cases

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Rapid-Eye-Movement Sleep Behavior Disorder

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Abstract

REM sleep behavior disorder (RBD) can be a clinical conundrum representing a diagnostic challenge for clinicians who are not familiar with it. This chapter highlights the diverse clinical presentations that often predispose the emergence of dream enactment behaviors in neurologic conditions. Cases will be discussed where RBD emerged in the setting of autoimmune limbic encephalitis in the vicinity of the rostral pons and in the setting of hypocretin (orexin) deficiency syndrome due to neurosarcoidosis of the diencephalon. Discussion will also review the challenge of disclosure of the diagnosis of RBD and disclosure of the prognostic implications of RBD as it relates to the implications of neurodegeneration later in life. Finally, a case of a young woman on antidepressants will be provided, covering newly emerging data implicating this class of medications in dream enactment behaviors and REM sleep without atonia.

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References

  1. Iranzo A, Graus F, Clover L, et al. Rapid eye movement sleep behavior disorder and potassium channel antibody-associated limbic encephalitis. Ann Neurol. 2006;59:178–81.

    Article  PubMed  Google Scholar 

  2. Lopez J, Blanco Y, Graus F, Saiz A. Clinical and immunological profile of limbic encephalitis associated with voltage-gated potassium channel antibodies [Spanish]. Med Clin (Barc). 2009;133:224–8.

    Article  Google Scholar 

  3. Lin FC, Liu CK, Hsu CY. Rapid-eye-movement sleep behavior disorder secondary to acute aseptic limbic encephalitis. J Neurol. 2009;256:1174–6.

    Article  PubMed  Google Scholar 

  4. Jennum P, Christensen JA, Zoetmulder M. Neurophysiological basis of rapid eye movement sleep behavior disorder: informing future drug development. Nat Sci Sleep. 2016;8:107–20.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Arnulf I. REM sleep behavior disorder: motor manifestations and pathophysiology. Mov Disord. 2012;27:677–89.

    Article  PubMed  Google Scholar 

  6. Aurora RN, Zak RS, Maganti RK, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6:85–95.

    PubMed  PubMed Central  Google Scholar 

  7. Iranzo A, Fernández-Arcos A, Tolosa E, et al. Neurodegenerative disorder risk in idiopathic REM sleep behavior disorder: study in 174 patients. PLoS One. 2014;9(2):e89741. https://doi.org/10.1371/journal.pone.0089741.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Arnaldi D, Antelmi E, St Louis EK, Postuma RB, Arnulf I. Idiopathic REM sleep behavior disorder and neurodegenerative risk: to tell or not to tell to the patient? How to minimize the risk? Sleep Med Rev. 2016;36:82–95.

    Article  PubMed  Google Scholar 

  9. Vertrees S, Greenough GP. Ethical considerations in REM sleep behavior disorder. Neurology (Continuum). 2013;19(1 Sleep Disorders):199–203.

    Google Scholar 

  10. Johnson BP, Westlake KP. The link between Parkinson’s disease and rapid eye movement sleep behavior disorder with dream enactment: possible implications for early rehabilitation. Arch Phys Med Rehabil. 2018;99(2):411–5. https://doi.org/10.1016/j.apmr.2017.08.468. pii: S0003-9993(17)31073-0.

    Article  PubMed  Google Scholar 

  11. Aldrich MS, Naylor MW. Narcolepsy associated with lesions of the diencephalon. Neurology. 1989;39:1505–8.

    Article  CAS  PubMed  Google Scholar 

  12. Servan J, Marchand F, Garma L, Seilhean D, Hauw JJ, Delattre JY. Narcolepsy disclosing neurosarcoidosis [French]. Rev Neurol. 1995;151:281–3.

    PubMed  CAS  Google Scholar 

  13. Rubinstein I, Gray TA, Moldofsky H, Hoffstein V. Neurosarcoidosis associated with hypersomnolence treated with corticosteroids and brain irradiation. Chest. 1988;94:205–6.

    Article  CAS  PubMed  Google Scholar 

  14. Mayer G. Efficacy of sodium oxybate on REM sleep behavior disorder in a patient with narcolepsy type 1. Neurology. 2016;87:2594–5.

    Article  PubMed  Google Scholar 

  15. Moghadam KK, Pizza F, Primavera A, Ferri R, Plazzi G. Sodium oxybate for idiopathic REM sleep behavior disorder: a report on two patients. Sleep Med. 2017;32:16–21.

    Article  PubMed  Google Scholar 

  16. Shneerson JM. Successful treatment of REM sleep behavior disorder with sodium oxybate. Clin Neuropharmacol. 2009;32:158–9.

    Article  CAS  PubMed  Google Scholar 

  17. Lu J, Sherman D, Devor M, Saper CB. A putative flip-flop switch for control of REM sleep. Nature. 2006;441:589–94.

    Article  CAS  PubMed  Google Scholar 

  18. Saper CB, Fuller PM. Wake-sleep circuitry: an overview. Curr Opin Neurobiol. 2017;44:186–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. McCarter SJ, St Louis EK, Boeve BF. REM sleep behavior disorder and REM sleep without atonia as an early manifestation of degenerative neurological disease. Curr Neurol Neurosci Rep. 2012;12:182–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Knudsen S, Gammeltoft S, Jennum PJ. Rapid eye movement sleep behaviour disorder in patients with narcolepsy is associated with hypocretin-1 deficiency. Brain. 2010;133:568–79.

    Article  PubMed  Google Scholar 

  21. Nomura T, Kawase S, Watanabe Y, Nakashima K. Use of ramelteon for the treatment of secondary REM sleep behavior disorder. Intern Med. 2013;52:2123–6.

    Article  PubMed  Google Scholar 

  22. Howell MJ, Arneson PA, Schenck CH. A novel therapy for REM sleep behavior disorder (RBD). J Clin Sleep Med. 2011;7:639–44.

    PubMed  PubMed Central  Google Scholar 

  23. Thunker J, Pietrowsky R. Effectiveness of a manualized imagery rehearsal therapy for patients suffering from nightmare disorders with and without a comorbidity of depression or PTSD. Behav Res Ther. 2012;50:558–64.

    Article  PubMed  Google Scholar 

  24. Aurora RN, Zak RS, Auerbach SH, et al. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010;6:389–401.

    PubMed  PubMed Central  Google Scholar 

  25. Schenck CH, Mahowald MW, Kim SW, O’Connor KA, Hurwitz TD. Prominent eye movements during NREM sleep and REM sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder. Sleep. 1992;15:226–35.

    Article  CAS  PubMed  Google Scholar 

  26. Ju YE, Larson-Prior L, Duntley S. Changing demographics in REM sleep behavior disorder: possible effect of autoimmunity and antidepressants. Sleep Med. 2011;12:278–83.

    Article  PubMed  Google Scholar 

  27. Postuma RB, Gagnon JF, Tuineaig M, Bertrand JA, Latreille V, Desjardins C, Montplaisir JY. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? Sleep. 2013;36:1579–85.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Husain AM, Miller PP, Carwile ST. REM sleep behavior disorder: potential relationship to post-traumatic stress disorder. J Clin Neurophysiol. 2001;18:148–57.

    Article  CAS  PubMed  Google Scholar 

  29. McCarter SJ, St Louis EK, Sandness DJ, et al. Antidepressants increase REM sleep muscle tone in patients with and without REM sleep behavior disorder. Sleep. 2015;38:907–17.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. UCLA Department of Neurology, UCLA Sleep Disorders Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Alon Y. Avidan MD, MPH

Authors
  1. Alon Y. Avidan MD, MPH
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Correspondence to Alon Y. Avidan MD, MPH .

Editor information

Editors and Affiliations

  1. Minnesota Regional Sleep Disorders Center, Departments of Psychiatry, University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, MN, USA

    Carlos H. Schenck

  2. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    Birgit Högl

  3. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Aleksandar Videnovic

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Avidan, A.Y. (2019). Clinical Vignettes: Illustrative, Unusual, and Challenging RBD Cases. In: Schenck, C., Högl, B., Videnovic, A. (eds) Rapid-Eye-Movement Sleep Behavior Disorder. Springer, Cham. https://doi.org/10.1007/978-3-319-90152-7_22

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  • DOI: https://doi.org/10.1007/978-3-319-90152-7_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90151-0

  • Online ISBN: 978-3-319-90152-7

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