Thursday, September 24, 2009

REM Behavior Disorder (RBD) Random Pearls

1. Differential diagnosis might include nocturnal seizures, which would occur earlier in night during NREM sleep; may or may not be able to diagnose without video/EEG
2. Differential diagnosis would include OSA which causes disruptions in sleep architecture and increased nighttime arousals so sleep study for that problem would be useful (pseudoRBD)
3. Drugs that cause/exacerbate include SSRI's, TCA's, MAO A inh, ETOH withdrawal,
4. Actions can be purposeful violence as patients are actually enacting dreams which are violent
5. Dreams of being chased are common (50 v. 8 % in RBD v. non RBD PD patients)
6. Associated with synucleinopathies ie. PD, CBD, LBD (52 % risk at 12 years)
7. Environmental precautions are medicolegally important including separate beds, locking windows, etc.
8. Effectively treated in 90 % with clonazepam, with most of the rest treated with carbamazepine.
9. Patients can have nonviolent behaviors as well as violent ones including included masturbating-like behavior and coitus-like pelvic thrusting, mimicking eating and drinking, urinating and defecating, displaying pleasant behaviors (laughing, singing, dancing, whistling, smoking a fictive cigarette, clapping and gesturing "thumbs up"), greeting, flying, building a stair, dealing textiles, inspecting the army, searching a treasure, and giving lessons. Speeches were mumbled or contained logical sentences with normal prosody. In PD with RBD (n = 60), 18% of patients displayed nonviolent behaviors. In this series (but not in incidental cases), all RBD patients with nonviolent behaviors also showed violent behaviors. NEUROLOGY 2009;72:551-557

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