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Review article- RBD clinical/pathophysiological relevance
There was one new item related to diagnosis in this abstract of recently-published Spanish research into RBD (REM sleep behavior disorder): "Polysomnography with audiovisual recording is needed to confirm the diagnosis of RBD and to exclude other sleep disorders that can mimic its symptoms including obstructive sleep apnea, nocturnal hallucinations and confusional awakenings."
This review article distinguishes between secondary RBD (or, RBD that is related to a neurodegenerative disorder such as MSA, PD, or DLB) and idiopathic RBD (which doesn't occur with a neurodegenerative disorder). Interestingly, the abstract suggests that there are "neuroprotective strategies" that may be helpful when someone has idiopathic RBD. I don't know what these strategies are and what such strategies would be neuroprotective against.
Sleep Medicine Reviews. 2009 Apr 8. [Epub ahead of print]
The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases.
Iranzo A, Santamaria J, Tolosa E.
Neurology Service, Hospital ClÃnic and Institut d'InvestigaciÃ³ BiomÃ¨diques August Pi i Sunyer (IDIBAPS), Centro de InvestigaciÃ³n BiomÃ©dica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
REM sleep behavior disorder (RBD) is characterized by vigorous movements associated with unpleasant dreams and increased electromyographic activity during REM sleep. Polysomnography with audiovisual recording is needed to confirm the diagnosis of RBD and to exclude other sleep disorders that can mimic its symptoms including obstructive sleep apnea, nocturnal hallucinations and confusional awakenings.
RBD may be idiopathic or related to neurodegenerative diseases, particularly multiple system atrophy, Parkinson's disease and dementia with Lewy bodies. RBD may be the first manifestation of these disorders, antedating the onset of parkinsonism, cerebellar syndrome, dysautonomia, and dementia by several years. RBD should thus be considered an integral part of the disease process.
When effective, neuroprotective strategies should be considered in subjects with idiopathic RBD.
Patients with other neurodegenerative diseases, though, such as spinocerebellar ataxias, may also present with RBD.
When clinically required, clonazepam at bedtime is effective in decreasing the intensity of dream-enacting behaviors and unpleasant dreams in both the idiopathic and secondary forms.
When part of a neurodegenerative disorder the development of RBD is thought to reflect the location and extent of the underlying lesions involving the REM sleep centers of the brain (e.g., locus subceruleus, amygdala, etc.), leading to a complex multiple neurotransmitter dysfunction that involves GABAergic, glutamatergic and monoaminergic systems. RBD is mediated neither by direct abnormal alpha-synuclein inclusions nor by striatonigral dopaminergic deficiency alone.
PubMed ID#: 19362028 (see pubmed.gov for abstract only)