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EL TRASTORNO DE CONDUCTA DURANTE EL SUEÑO REM

EL TRASTORNO DE CONDUCTA DURANTE EL SUEÑO REM,A. Iranzo

EL TRASTORNO DE CONDUCTA DURANTE EL SUEÑO REM  
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REM sleep behavior disorder (RBD) is a parasomnia characterized by dream-enacting behaviors related to unpleasant dreams and loss of the normal REM sleep muscle atonia. The pathophysiology of RBD is mediated by direct or indirect abnormalities in the brainstem structures that regulate REM sleep, particularly the sublocus coeruleus. RBD may be idiopathic or associated with neurological diseases such as Parkinson's di- sease, dementia with Lewy bodies, multiple system atrophy, narcolepsy and Machado-Joseph disease. In these conditions, RBD may precede the onset of the motor or cognitive symptoms by several years. In the idiopathic form subjects have no waking motor or cognitive complaints and their neurologic examination is normal. However, these patients exhibit asymptomatic abnormalities such as visuospatial constructional impair- ment, autonomic dysfunction, olfactory impairment, and reduced nigrostriatal dopaminergic innervation, which are common features in neuro- degenerative diseases, even at the early stages. Subjects presenting to sleep centres and diagnosed with idiopathic RBD are at increased risk for developing a neurodegenerative disease, particularly Parkinson' disease and dementia with Lewy bodies. RBD may be not considered as a sole sleep disorder rather a manifestation of a neurological disease. Treatment of choice of RBD is small doses of clonazepam (0.25-4 mg) at bed time.
Published in 2010.
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