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NEUROLOGY 1996;46:388-393
© 1996 American Academy of Neurology

Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder

Carlos H. Schenck, MD, Scott R. Bundlie, MD and Mark W. Mahowald, MD

From the Minnesota Regional Sleep Disorders Center and Departments of Psychiatry (Dr. Schenck) and Neurology (Drs. Bundlie and Mahowald), Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, MN.
This work was supported in part by a grant from Hennepin Faculty Associates.
Received March 7, 1995. Accepted in final form June 20, 1995.
Address correspondence to Dr. Carlos H. Schenck, Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, 701 Park Ave. South (Psych 844), Minneapolis, MN 55415.

We report longitudinal data on a group of 29 male patients 50 years of age or older who were initially diagnosed as having idiopathic REM sleep behavior disorder (RBD) after extensive polysomnographic and neurologic evaluations.Thirty-eight percent (11/29) were eventually diagnosed as having a parkinsonian disorder (presumably Parkinson's disease) at a mean interval of 3.7 plus minus 1.4 (SD) years after the diagnosis of RBD, and at a mean interval of 12.7 plus minus 7.3 years after the onset of RBD. To date, only 7% (2/29) of patients have developed any other neurologic disorder. At the time of RBD diagnosis, data from the RBD group with eventual Parkinson's disease (n equals 11) and the current idiopathic RBD group (n equals 16) were indistinguishable, with two exceptions: the RBD-Parkinson's disease group had a significantly elevated hourly index of periodic limb movements of non-REM sleep and an elevated REM sleep percentage. RBD was fully or substantially controlled with nightly clonazepam treatment in 89% (24/27) of patients in both groups. Thus, RBD can be the heralding manifestation of Parkinson's disease in a substantial subgroup of older male RBD patients. However, a number of presumed Parkinson's disease patients may eventually be diagnosed with multiple system atrophy (straitonigral degeneration subtype). Our findings indicate the importance of serial neurologic evaluations after RBD is diagnosed and implicate the pedunculopontine nucleus as a likely site of pathology in combined RBD-Parkinson's disease, based on experimental and theoretical considerations rather than on autopsy data.

NEUROLOGY 1996;46: 388-393




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