A case of differential diagnosis of REM sleep behavior disorder and sleep-related hypermotor epilepsy

   Aim. To describe a clinical case of differential diagnostics of motor phenomena during sleep.

   Materials and methods. Patient B., 37 years old. Visit to a somnologist at the University Clinic. Complaints were mainly made by the patient’s wife, since the patient himself does not remember these episodes. According to the wife, sudden sweeping movements of the arms and legs, incoherent speech are noted during sleep, then the patient gets up, can grab his hands, behaves aggressively, shifts things. These complaints have been noted for more than 10 years, with a gradual worsening of symptoms. A neurologist at the place of residence suggested a possible epileptic nature of these episodes,
but no further examination was carried out.

   Results. From a semiological point of view, motor phenomena during sleep can imitate epileptic seizures, parasomnias, rapid eye movement behavior disorders, and normal sleep motor phenomena such as fragmentary sleep myoclonus, periodic limb movements, bruxism, etc. A differential diagnostic search is provided, a comparative characteristic of motor phenomena during sleep and wakefulness is given, as well as a scale of frontal epilepsy and parasomnia, which can help the doctor in making the correct diagnosis.

   Conclusion. Conducting a comprehensive examination of the patient and clarifying the clinical diagnosis made it possible to choose the correct management tactics, avoid unjustified prescription of antiepileptic drugs, and reduce emotional stress in the family due to the ambiguity of the manifestations of night motor phenomena. The established clinical diagnosis allows monitoring the patient in terms of the possible debut of a neurodegenerative disease.

1. Heidbreder A., Möddel G. Non-REM-Parasomnie oder Frontallappenepilepsie – Warum sollte man genau hinschauen? Klinische Neurophysiologie 2016;47(3):117–24. (In German). DOI: 10.1055/s-0042-110083

2. Bjorvatn B., Grønli J., Pallesen S. Prevalence of different parasomnias in the general population. Sleep Med 2010;11(10):1031–4. DOI: 10.1016/j.sleep.2010.07.011

3. Haberlandt E. Parasomnia in children and adults as a differential diagnosis to non-lesional focal epilepsy. English version. Clinicak Epileptol 2023;36(Suppl 2):169–75. DOI: 10.1007/s10309-023-00609-w

4. Frenette E., Guilleminault C. Nonepileptic paroxysmal sleep disorders. Handb Clin Neurol 2013;112:857–60. DOI: 10.1016/B978-0-444-52910-7.00006-4

5. Bargiotas P., Bassetti C.L. Sleep-related movement disorders and disturbances of motor control. Curr Opin Neurol 2017;30(4):405–15. DOI: 10.1097/WCO.0000000000000466

6. Frauscher B., Gabelia D., Mitterling T. et al. Motor events during healthy sleep: a quantitative polysomnographic study. Sleep 2014;37(4):763–73, 773A–773B. DOI: 10.5665/sleep.3586

7. Silvestri R., Walters A.S. Rhythmic movements in sleep disorders and in epileptic seizures during sleep. Sleep Science and Practice 2020;4(1):5. DOI: 10.1186/s41606-020-0042-6

8. Tinuper P., Provini F., Bisulli F. et al. Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep. Sleep Med Rev 2007;11(4):255–67. DOI: 10.1016/j.smrv.2007.01.001

9. Derry C.P., Davey M., Johns M. et al. Distinguishing sleep disorders from seizures: diagnosing bumps in the night. Arch Neurol 2006;63(5):705–9. DOI: 10.1001/archneur.63.5.705

10. Boursoulian L.J., Schenck C.H., Mahowald M.W., Lagrange A.H. Differentiating parasomnias from nocturnal seizures. J Clin Sleep Med 2012;8(1):108–12. DOI: 10.5664/jcsm.1676

11. Dauvilliers Y., Schenck C.H., Postuma R.B. et al. REM sleep behaviour disorder. Nat Rev Dis Primers 2018;4(1):19. DOI: 10.1038/s41572-018-0016-5

12. Högl B., Stefani A., Videnovic A. Idiopathic REM sleep behaviour disorder and neurodegeneration – an update. Nat Rev Neurol 2018;14(1):40–55. DOI: 10.1038/nrneurol.2017.157

13. Barber T.R., Muhammed K., Drew D. et al. Reward insensitivity is associated with dopaminergic deficit in rapid eye movement sleep behaviour disorder. Brain 2023;146(6):2502–11. DOI: 10.1093/brain/awac430

14. El Youssef N., Marchi A., Bartolomei F. et al. Sleep and epilepsy : A clinical and pathophysiological overview. Rev Neurol (Paris) 2023;179(7):687–702. DOI: 10.1016/j.neurol.2023.07.006

15. Nodel’ M.R., Tsenteradze S.L., Poluéktov M.G. REM-sleep behavior disorder and sleepwalking in a patient with Parkinson’s disease and essential tremor. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2017; 117(12):88–94. (In Russ.). DOI: 10.17116/jnevro201711712188-94

16. Figorilli M., Meloni F., Lecca R. et al. Severity of REM sleep without atonia correlates with measures of cognitive impairment and depressive symptoms in REM sleep behaviour disorder. J Sleep Res 2023;32(5):e13880. DOI: 10.1111/jsr.13880

17. Howell M., Avidan A.Y., Foldvary-Schaefer N. et al. Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2023;19(4):759–68. DOI: 10.5664/jcsm.10424

18. Malkani R. REM Sleep Behavior Disorder and Other REM Parasomnias. Continuum (Minneap Minn) 2023;29(4):1092–116. DOI: 10.1212/CON.0000000000001293