Objective: 1) Characterize dream enactment motor events (ME) during REM sleep behavioral disorder (RBD) episodes in Parkinson’s disease (PD); 2) Assess the relation between ME and daytime motor dysfunction; 3) Compare ME between PD and idiopathic RBD patients.

Background: The hypothesis that Parkinsonian symptoms do not affect PD patients during RBD dream enacting episodes could be relevant for investigating alternative pathways for motor dysfunction treatment. Dream enacting also occurs in idiopathic RBD patients, who do not suffer from relevant motor dysfunction. If motor function restoration does occur, we would be expect a dissociation between ME and awake state motor dysfunction in PD and no significant differences regarding iRBD.

Methods: Seventeen PD-RBD and 19 iRBD patients underwent a one-night video-polysomnography study. Sleep stages and REM sleep muscular tone were scored according to the American Academy of Sleep Medicine manual. RBD diagnosis followed the International Classification of Sleep Disorders criteria. PD motor function was assessed with the Hoehn and Yahr scale and the Unified Parkinson’s disease Rating Scale and separate scores were derived for bradykinesia, rigidity and tremor. ME were scored according to the scale published by Frauscher B et al. (2007), which rates movement events in video records according to type, complexity, body region, extension, symmetry, proximal vs. distal and emotional tone.

Results: Three PD-RBD and 1 iRBD did not present ME. In PD-RBD, number of ME per patient ranged from 1 to 44 (mean 12.21) and mean duration ranged from 2 to 240 scs (mean 68.71). ME affected predominantly the lower limbs and were most frequently elementary, simple, emotionally negative, distal, focal or segmental and as frequently symmetric as asymmetric. There were no significant differences regarding iRBD. There were significant, positive correlations between tremor score and percentage of multifocal, myoclonic and lower limbs ME.

Conclusions: ME in PD-RBD were predominantly simple, distal and focal. Similarity of ME to those in iRBD patients and non-correlation with most UPDRS scores partially supports the hypothesis of motor function restoration during RBD, but a possible relation between tremor severity and ME (particullarly of the myoclonic type) was apparent, which could be caused by interference of that specific symptom on ME or to a shared physiopathology.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/motor-function-restoration-during-rem-sleep-behavioral-disorder-in-parkinsons-disease-a-vdeo-polysomnography-study/