Thread by @MedinaRiojaMD

REM Sleep Behavior Disorder (RBD): what Miguel de Cervantes and Cinderella taught us. 😴😴💤🧠🧠👸✍️

A brief tweetorial.

#Neuro #NeuroTwitter #EndNeurophobia #Teaching #NeuroEducation #Sleep #RBD

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The following thread has the objective to describe (in a general way) the main features of RBD, for more details, feel free to check the sources that I will add at the end of the tweetorial.

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🥇What is REM sleep?
Sleep is divided in 4 phases, each of them is repeated during the 🌕in a cycle.

N1: vertex waves
N2: sleep spindles, k complexes
N3: slow-wave-sleep (restorative phase)
REM: rapid horizontal eye movement occurs, we dream and there is no muscle tone

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🥈What is RBD?
It is characterized by abnormal behaviours, usually dream enactments, and an excess of muscle tone and/or phasic muscle twitching during REM sleep.

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Miguel de Cervantes in his "Don Quixote" describes many sleep disorders including RBD. 🇪🇸

Chapter XXXV of the first book.🏇

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Ahora en español porque me gusta más como se lee.
Parte 1, capítulo XXXV. 🇪🇸🏇

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And Disney knew something as well. In the film Cinderella (1950) there is a scene where Bruno 🐶is acting his dreams.

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Clinical symptoms:
Patients tend to act their dreams. They speak, kick, shout, grab and even have complex (self-injurious) movements during the night.
🦵🥊🏃🗣️

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Pathophysiology
Degeneration of the inhibitory centres in charge of inhibition of movement during REM sleep is one of the main mechanisms, but there is still much that we ignore about it. (SLD and GiV/LPGi)🧠🧠

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🏷️🧪Diagnosis
Polysomnography is always needed🚨

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It is divided in two:

1⃣ Idiopathic: no other symptoms
2⃣ Symptomatic: associated with a degenerative disease (alpha-synucleinopathy related disorder)

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Idiopathic RBD may remain stable or evolve to a more definitive alpha-synuclein pahtology related disorder.
Lewy body dementia
Parkinson's disease
Multiple system atrophy.
🧠🏷️

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🏷️In recent cohorts and series this evolution has been studied:

2014 Spanish cohort: 174 patients, after 14 years 90% developed some type of neurodegenerative disorder

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🏷️In recent cohorts and series this evolution has been studied:

2013 UpDate on Mayo Clinic cohort: 80% of their cohort developed Parkinsonism/dementia.

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📋More recently a publication in 🧠described risk factors that increased the rate of phenoconversion.
👇⬇️

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Therefore early detection and strict follow-up is mandatory. 🚨🚨

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💊Treatment is mostly asymptomatic.
The basis of the current medications is to suppress the REM sleep phase and reduce abnormal movements during the night.

1⃣ Melatonin
2⃣ Clonazepam

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For a more updated review on the treatment options and a summary of the main clinical trails regarding treatment. I suggest read the next paper.

🔽

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I hope you have enjoyed this thread and next time you see a patient, don't forget to ask about her/his sleep habits.
🛌💤

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End.

Sources:
1.- Neurobiol Dis. 2012 Jun;46(3):553-8.
doi: 10.1016/j.nbd.2011.10.003
2.- Continuum (Minneap Minn). 2020 Aug;26(4):848-870. doi: 10.1212/CON.0000000000000878
3.- Nat Rev Neurol. 2018 Jan;14(1):40-55.
doi: 10.1038/nrneurol.2017.157.

More sources:
4.- Mayo Clin Proc. 2017 Nov;92(11):1723-1736.
doi: 10.1016/j.mayocp.2017.09.007
5.- PLoS One. 2014 Feb 26;9(2):e89741.
doi: 10.1371/journal.pone.0089741
6.- Sleep Med. 2013 Aug;14(8):744-8.
doi: 10.1016/j.sleep.2012.10.009

Sources :)
7.- Brain. 2019 Mar 1;142(3):744-759.
doi: 10.1093/brain/awz030
8.- J Pers Med. 2021 Nov 14;11(11):1204.
doi: 10.3390/jpm11111204