REM sleep behavior disorder: relevance to epileptologists

Abstract

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia that features loss of the generalized skeletal muscle atonia of mammalian REM sleep, with release of injurious dream-enacting behaviors. Video-polysomnography is necessary to confirm the diagnosis. Our aim was to provide a relevant update on RBD for electroencephalography (EEG) and epilepsy specialists. This study comprised a focused literature review. Typical and atypical RBD clinical profiles are presented and discussed. Official diagnostic criteria are listed and experimental animal models are reviewed. The differential diagnosis, including nocturnal seizures, is considered, and EEG, evoked potential, and sleep spindle findings are presented. Emphasis is placed on idiopathic RBD as a common herald of future alpha-synucleinopathy neurodegeneration (Parkinson’s disease, dementia with Lewy bodies, multiple system atrophy). Furthermore, we describe the formation of the International RBD Study Group in 2009 with yearly research symposia. RBD comprises a fascinating, multidimensional parasomnia that needs to be considered in the differential diagnosis of nocturnal epilepsy with abnormal sleep-related behaviors in order to facilitate identifying the correct diagnosis and to initiate proper therapy.