REM sleep behavior disorder and REM sleep without atonia as an early manifestation of degenerative neurological disease

Stuart J. McCarter, Erik K. St. Louis, Bradley F. Boeve

Research output: Contribution to journalReview articlepeer-review

87 Scopus citations


Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by repeated episodes of dream enactment behavior and REM sleep without atonia (RSWA) during polysomnography recording. RSWA is characterized by increased phasic or tonic muscle activity seen on polysomnographic electromyogram channels. RSWA is a requisite diagnostic feature of RBD, but may also be seen in patients without clinical symptoms or signs of dream enactment as an incidental finding in neurologically normal individuals, especially in patients receiving antidepressant therapy. RBD may be idiopathic or symptomatic. Patients with idiopathic RBD often later develop other neurological features including parkinsonism, orthostatic hypotension, anosmia, or cognitive impairment. RSWA without clinical symptoms as well as clinically overt RBD also often occurs concomitantly with the α-synucleinopathy family of neurodegenerative disorders, which includes idiopathic Parkinson disease, Lewy body dementia, and multiple system atrophy. This review article considers the epidemiology of RBD, clinical and polysomnographic diagnostic standards for both RBD and RSWA, previously reported associations of RSWA and RBD with neurodegenerative disorders and other potential causes, the pathophysiology of which brain structures and networks mediate dysregulation of REM sleep muscle atonia, and considerations for the effective and safe management of RBD.

Original languageEnglish (US)
Pages (from-to)182-192
Number of pages11
JournalCurrent neurology and neuroscience reports
Issue number2
StatePublished - Apr 2012


  • Braak staging
  • Clonazepam
  • Melatonin
  • Neurodegeneration
  • Neurological disease
  • Neuropsychological testing
  • Parasomnia
  • Parkinsonism
  • REM sleep behavior disorder
  • REM sleep without atonia
  • Treatment
  • α-synucleinopathy

ASJC Scopus subject areas

  • General Neuroscience
  • Clinical Neurology


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