REM sleep behavior disorder: motor manifestations and pathophysiology
Abstract
Patients with REM sleep behavior disorder (RBD) enact violent dreams during REM sleep in the absence of normal muscle atonia. This disorder is highly frequent in patients with synucleinopathies (60%-100% of patients) and rare in patients with other neurodegenerative disorders. The disorder is detected by interview plus video and sleep monitoring. Abnormal movements expose the patients and bed partners to a high risk of injury and sleep disruption. The disorder is usually alleviated with melatonin and clonazepam. Limb movements are mainly minor, jerky, fast, pseudohallucinatory, and repeated, with a limp wrist during apparently grasping movements, although body jerks and complex violent (fights) and nonviolent culturally acquired behaviors are also observed. Notably, parkinsonism disappears during RBD-associated complex behaviors in patients with Parkinson's disease and with multiple system atrophy, suggesting that the upper motor stream bypasses the basal ganglia during REM sleep. Longitudinal studies show that idiopathic RBD predisposes patients to later develop Parkinson's disease, dementia with Lewy bodies, and, more rarely, multiple system atrophy, with a rate of conversion of 46% within 5 years. During this time window, patients concomitantly develop nonmotor signs (decreased olfaction and color vision, orthostatic hypotension, altered visuospatial abilities, increased harm avoidance) and have abnormal test results (decreased putamen dopamine uptake, slower EEG). Patients with idiopathic RBD have higher and faster risk for conversion to Parkinson's disease and dementia with Lewy bodies if abnormalities in dopamine transporter imaging, transcranial sonography, olfaction, and color vision are found at baseline. They constitute a highly specific target for testing neuroprotective agents.
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The DEB can be a viable access to dreams, overcoming the intrinsic difficulty to study dreaming.
“Finally, considering that dreaming is an irregular phenomenon and not always observable, it should be considered that a new frontier to investigate more directly the relationship between dreaming and emotions is represented by the DEB (Rivera-García et al., 2018) that can be a viable access to dreams, overcoming the intrinsic difficulty to study this phenomenon (Arnulf, 2012; Alfonsi et al., 2019)”
From The Functional Role of Dreaming in Emotional Processes (2019) · cites this paper as Arnulf, 2012
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Smiling asleep: A study of happy emotional expressions during adult sleep
Clé, M., Maranci, J., Banningh, S. W., Lanfranchi, J., Vidailhet, M., & Arnulf, I. (2019) · Journal of Sleep Research · doi:10.1111/jsr.12814 · Cited by 25 · see citing works
Self-citationThe fate of patients with REM sleep behavior disorder and mild cognitive impairment
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Is there a common motor dysregulation in sleepwalking and REM sleep behaviour disorder?
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Clinical Overview of REM Sleep Behavior Disorder
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- Authors
- Arnulf, I.
- Affiliations
- Inserm (FR)
- Corresponding author
- Arnulf, Isabelle
- ORCID
- Arnulf, Isabelle
- Venue
- Movement Disorders
- Publisher
- Wiley
- Published
- 2012-03-22
- Volume
- 27
- Issue
- 6
- Pages
- 677-689
- ISSN
- 0885-3185 (ISSN-L)
- 1531-8257
- OpenAlex
- W2057270473
- Cited by
- 231
- References
- 105
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 11 · 2023: 13 · 2022: 13 · 2021: 19 · 2020: 12 · 2019: 18 · 2018: 16 · 2017: 20 · 2016: 23 · 2015: 19 · 2014: 17 · 2013: 18 · 2012: 5
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Movement Disorders (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- REM sleep behavior disorder, synucleinopathies, Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, REM sleep atonia, dopamine transporter imaging, olfactory dysfunction, color vision deficiency, orthostatic hypotension, melatonin, clonazepam, basal ganglia, neurodegeneration risk
- MeSH terms
- Cognition Disorders, Dementia, Humans, Parkinson Disease, Sleep, REM, REM Sleep Behavior Disorder
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