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Individuals with PD, RBD exhibit improved motor control during REM sleep, data suggest

Thursday, December 13 2007 | Comments

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What's This? Individuals with both Parkinson's disease and REM sleep behavior disorder (RBD) seem to experience a restoration of normal motor control during REM sleep, new study findings suggest.

Investigators interviewed 100 patients with PD and their bed partners using a structured questionnaire to identify those with RBD symptoms.

Of the 59 patients with clinical RBD, 53 had bed partners who provided data about the patient's movement, voice, and facial expressions during an RBD episode. Bed partners were asked to rate each of these as better than, worse than, or equal to those observed during waking hours after a levodopa dose.

All bed partners reported the patient had a relative improvement in ≥1 component of motor control during an RBD episode. Specifically, movement improved in 87% of the patients (faster in 87%, stronger in 87%, and smoother in 51%), speech improved in 77% (more intelligible in 77%, louder in 38%, and better articulated in 57%), and facial expressions became normal in 47%.

Thirty-six patients with clinical RBD symptoms and 15 patients without such symptoms underwent video monitoring and polysomnography (PSG). PSG confirmed the RBD diagnosis in 35 of the 36 patients with RBD symptoms and revealed RBD in 6 of the 15 patients without symptoms (41 total cases of RBD confirmed).

Video monitoring suggested that the movements of individuals with RBD were "surprisingly fast, ample, coordinated, and symmetrical, without obvious signs of parkinsonism," according to the researchers. However, they acknowledged that these movements were also jerky, violent, and often repeated.

The investigators added that the percentage of time with tremor (documented with electromyography) was 34.9% during wakefulness, 3.6% during sleep stages 1 and 2, 1.4% during sleep stages 3 and 4, and 0.06% during REM sleep (subclinical tremor).

The restored motor control during REM sleep "suggests a transient 'levodopa-like' reestablishment of the basal ganglia loop. Alternatively, parkinsonism may disappear by an REM sleep-related disjunction between the pyramidal and extrapyramidal systems," they concluded. (Cochen V, et al. Poster 02.039.)

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