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Dissoziationen im REM-Schlaf-Klinik und Pathophysiologie

Dissociation in REM sleep—Symptoms and pathophysiology

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Zusammenfassung

Die REM-Schlafverhaltensstörung ist die bedeutendste Dissoziation im REM-Schlaf und REM-Schlaf-assoziierte Parasomnie. Obwohl bereits 1965 im tierexperimentellen Versuch vorausgesehen, wurde sie erstmals 1986 beim Menschen beschrieben. Sie ist gekennzeichnet durch Aufhebung der REM-Atonie mit Ausagieren der Trauminhalte. Tierexperimentell können durch umschriebene Hirnstammläsionen unterschiedliche Verhaltensmuster generiert werden, die sich auch beim Menschen finden. Zentren, die Muskelatonie und phasische Muskelaktivität steuern, konnten lokalisiert werden. Verlaufsbeobachtungen haben gezeigt, daß viele ursprünglich als idiopathisch diagnostizierte Formen Vorboten neurodegenerativer Erkrankungen sind. Postmortale Hirngewebsuntersuchungen von Patienten mit REM-Schlafverhaltensstörung zeigten Lewy-Körper in Locus coeruleus und Substantia nigra. Die Störung ist am besten mit niedrigdosiertem Clonazepam behandelbar.

Summary

REM sleep behavior disorder is the most important dissociation in REM sleep and in REM sleep-associated parasomnias. Although predicted by animal experience in 1965 this disorder has been reported in humans as late as 1986. Its central feature is disinhibition of REM atonia and acting out dream contents in sleep. In animal studies several distinct behaviors can be induced by specific lesions of the brainstem that resemble those in humans. Centers generating muscle atonia und phasic muscle activity have been identified in animals. Longitudinal studies revealed initially diagnosed idiopathic cases to be predictors of neurodegenerative disorders. Postmortal investigation of brain tissue of patients with REM behavior disorder revealed Lewy bodies in the locus coeruleus und substantia nigra. The disorder can be effectively controlled by medication with low dose clonazapam.

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  1. Hephata-Klinik, Schimmelpfengstraße 2, D-34613, Schwalmstadt-Treysa

    G. Mayer

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Mayer, G. Dissoziationen im REM-Schlaf-Klinik und Pathophysiologie. Somnologie 3, 90–94 (1999). https://doi.org/10.1007/s11818-999-0016-5

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  • DOI: https://doi.org/10.1007/s11818-999-0016-5

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