REM sleep motor dysfunction in multiple system atrophy: with special emphasis on sleep talk as its early clinical manifestation

Abstract

REM sleep without atonia, first described in experimental cats with bilateral lesions in the dorsolateral pontine tegmentum, 1 was found to be associated with behavioural manifestations, ranging from REM sleep without atonia associated with no behavioural correlates to that with active locomotor disinhibition, depending on the location and size of the lesions.2 Experimental cats with active locomotion along with violent behaviours have been considered an animal model for REM sleep behaviour disorder seen in neurological diseases with brainstem lesions.3-5 Based on these experimental findings, we hypothesised that REM sleep motor dysfunction might occur even in patients with multiple system atrophy who do not report any nocturnal abnormal behaviours. Furthermore, by utilising all night polysomnography, the only method capable of detecting this kind of REM sleep abnormality that does not fulfill the criteria of REM sleep behaviour disorder, we aimed at elucidating how sleep related clinical symptoms are related to REM sleep motor dysfunction in patients with multiple system atrophy. Patients and methods PATIENTS

REM Sleep Behavior Disorder in Parkinson’s Disease and Dementia with Lewy Bodies

“…There are a few recent reports on RBD associated with spinocerebellar atrophy type 3 (Machado-Joseph disease). [63][64][65] As noted above, numerous cases of RBD have been reported in conjunction with MSA, 3,22,23,27,[66][67][68][69][70][71][72] PD, 3,11,22,[24][25][26][27][30][31][32][33][34][35]73 and DLB. 1,10,15,41,45,[47][48][49][50][51][52][53]55,59,60,74 Although frequency data on the presence of RSWA and RBD in the neurodegenerative disorders is based on relatively small numbers of patients thus far, the presence of each in MSA has been reported to be 90% to 95% for RSWA and 68% to 90% for RBD, 66,67 and presence of each in PD is approximately 58% for RSWA and 33% for RBD.…”

Cognitive and Sleep Features of Multiple System Atrophy: Review and Prospective Study

“…RBD is the most common sleep-related disorder in MSA [40,41,44,46,51,52] and may precede the development of parkinsonism by years [45,52,53,54]. Current knowledge indicates that up to 81-82% of patients with idiopathic RBD develop a parkinsonian disorder [55,56].…”

REM sleep behaviour disorder in Parkinson's disease

“…Although the authors described the behaviour as delirious, it seems to be regarded as RBD seen in MSA. In 1997, two studies showed that about 90 % of patients with MSA had RBD/RWA, based on polysomnographic recording as well as clinical features [24,37]. This high percentage of association could reflect diffuse brainstem pathology in MSA.…”