August 13, 2015: REM Behavior Disorder

Interested in submitting an E-Pearl?
Brought to you by the Residents & Fellows Section of Neurology.

August 13, 2015

REM Behavior Disorder

Rapid eye movement (REM) is characterized by persistent eye movements in the setting of muscle atonia during deep stages of sleep. REM behavior disorder (RBD) is a parasomnia in which muscle atonia is lost during this stage of sleep. Recognition of REM behavior disorder in patients with disturbed sleep has clinical implications as many patients go on to develop neurodegenerative diseases. It has been associated with α-synuclein, with approximately 80% of patients going on to develop synuclienopathies including Parkinson’s disease, multiple systems atrophy or Lewy body dementia. Symptomatically, patients or bed partners may describe simple acts such as talking or jerking during sleep. More commonly, movements are violent, often resulting in injurious behavior. Interestingly, dreams in patients with REM behavior disorder are often described as violent and frequently involve fighting. Electromyography monitoring reveals excessive chin activity or limb jerking, required for the diagnosis. Treatment has been variable. Previous studies have suggested striatal dopamine dysfunction, therefore dopamine agonists, such as Pramipexole, have been used with marginal success. Other treatment options include benzodiazepines and melatonin.


  1. Muntean ML, Sixel-Döring F, Trenkwalder C. REM behavior disorder in Parkinson’s disease. J Neural Transm Epub 2014 Mar 22.
  2. Peever J, Luppi PH, Montplaisir J. Breakdown in REM sleep circuitry underlies REM sleep behavior disorder. Trends Neurosci 2014; 37: 279-288.

Submitted by James Addington, M.D. Resident Physician, Department of Neurology, University of Virginia.

Disclosures: Dr. Addington is a member of the Residents & Fellows Section of Neurology

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.


Forgot password?