A Small Sample Of Case Control Study Of REM Behavior Disorder With A Case Report

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia featured by vivid and frequently frightening or violent dreams, often associated with simple or complex limb or vocal activities, which looks like to act out one’s dreams Vedio-polysomnography (vPSG) examination manifests rapid eye movement (REM) sleep without atonia (RSWA), that is increased tonic or phasic musle activities during REM. RBD can be idiopathic or secondary (sympotmatic). Idiopathic RBD (iRBD) often develop into parkinsonism, orthostatic hypotension (OH) or cognitive dysfunction. RBD also often occurs concomitantly with a-synucleinopathy, mostly Parkinsin disease (PD), multiple system atrophy (MSA) and dementia with Lewy body (DLB).RBD can be induced by drugs (tricyclic antidepressant,5-HT reuptake inhibitors and (3-adrenergic antagonist,etc) or other diseases (brain stem infarction, brain stem encephalitis, or other demyelinative diseases,etc). Research in animals and human neuropathology reveal that REM regulatory regions of brain stem and dopaminergic neurotransmission are responsible of the pathophysiology of RBD. We also argue the relationship between RBD and other neurodegenerative diseases, especially Alzheimer’s Disease (AD). We report a illustrative case of RBD with MSA. The patient is a59-year-old man with3months of progressive dyskinesia, who was diagnose with PD and prescribed with Madopar and amantadine. He took the drugs regularly with no release of his motor dysfunction. He complained of a moderate symmetrical extremity edema one week before admission. The patient has a5yeats history of RBD and has injured his wife several times. A detailed physical examination shows cerebellar ataxia, lead pipe-like rigidity, positive pyramidal sign but orthostatic hypotension. He experienced constipation3days after admission. The brain MRI manifests a vertical line in the middle of pons in T2W1. We confirmed the diagnosis of MSA instead. The withdrawl of amantadine did not cure swelling in hands and feet. Clonozapam is effective to relieve RBD. MSA and PD are similar in early stage symptoms, and yet RBD may be an early manifestations of MSA, PD or DLB. So we wonder if there is any difference in clinical features of RBD between MSA and PD; Meanwhile we explore the relationship between cigarets/alcohol and the occurrence of RBD. We selected consecutively, from inpatients hospitalized between2012-01-01to2013-03-15,22cases of MSA,19cases of PD,15cases of brain stem infarction and5cases of brain stem encephalitis. We also included20cases of Alzheimer’s disease(AD) from outpatents. Phone calls were made to ask if patients had the classic symptoms of RBD, according to the minimal criteria of RBD and several RBD questionnaires, and whoever had were diagnosed as clinical probable RBD(cpRBD). It turns out that there are13cases of cpRBD with MSA.9cases of cpRBD with PD, only one case of cpRBD with AD. The onset of cpRBD is earlier than that of MSA, while the onset of5cases of cpRBD happened years after PD. The manifestation of cpRBD is faint and infrequent in AD. The disease prevalence of cpRBD is no statistical difference between sex, yet female have a older onset age and longer duration than male. Cigarettes and alcohol appear to be no potential risk factor of cpRBD. This article also discuss the major difference in autonomic dysfunction, MRI manifestation and parkinsonism between MSA and PD. The epidemiology, diagnosis and pharmacological therapies of RBD is also reviewed.