Behavioral manifestation profile in idiopathic REM sleep hebavior disorder

Aim: Abnormally prominent motor activity in rapid eye movement (REM) sleep is a major polysomnographic (PSG) feature of idiopathic REM sleep behavior disorder. The diagnosis is based on the complex nature of the movements, but more discreet motor manifestations can be seen in the video m-zxdiry during PSG. The aim of this work was to perform a systematic video analysis of RLM sleep movements. Patients and methods: The motor manifestations identified in the video recording of PSG in 32 patients aged 67.4 +/- 7.3 years were classified into four categories according to clinical severity (elementary, excessive, scenic and violent). In addition, topographic distribution, brief and slow characterization of movement, association with vocalization, subsequent wakefulness and emotional subtext were determined for each motor event. Results: An average of 114.6 +/- 85.1 motor phenomena was identified. Of these, 67.8% were classified as elementary, 9.1% as excessive, 22.3% as scenic, and 0.7% as violent. However, 31.3% of patients experienced violent manifestations. Brief movements were more frequent than slow ones (P = 0.001). Vocalization occurred in 34.4% of patients. Movement caused wakefulness in 9.4% of patients and was at least once associated with distinct emotion in 21.9%. Conclusion: This study shows a large number of motor phenomena in REM sleep with extensive variability. Elementary events represent the vast majority. Although violent manifestations are captured in relative minority, they were detected in 31% of patients.