Rhythmic motion disturbance (or RMD ) is a neurological disorder characterized by involuntary (though sometimes voluntary), repetitive motion of large muscle groups immediately before and during frequent sleep involving the head and neck. It was independently described first in 1905 by Zappert as jactatio capitis nocturna and by Cruchet as rhythmie du sommeil . The majority of RMD episodes occur during NREM sleep, although REM movements have been reported. RMD is often associated with other psychiatric or mental disabilities. This disorder often causes bodily injury from unwanted movements. Due to this unrelieved muscle contraction, the sleep patterns of the patients are often disrupted. This differs from Restless Legs Syndrome in RMD which involves spontaneous muscle contraction before and during sleep while Restless Legs Syndrome is the impulse to move before bed. RMD occurs in men and women, often in early childhood with symptoms diminishing with age. Many sufferers also have other sleep related disorders, such as sleep apnea. These disorders can be diagnosed differently into small subcategories, including sleep related bruxism, thumb sucking, hypnagonic foot tremors, and rhythmic sucking, to name a few. In order to be pathological, ICSD-II requires that in sleep-related rhythmic movements should "significantly interfere with normal sleep, cause significant disturbance in daytime functioning, or result in self-inflicted body injuries requiring medical treatment (or will result in injury if action prevention is not used) ".
Video Rhythmic movement disorder
Signs and symptoms
Most symptoms of RMD are relatively passive and do not cause pain. Many patients are often unaware that an episode is happening or has occurred. Rhythmic movements can produce multiple bodily injuries through a fall or muscle strain, but this is not reported in all patients. In a unique case, the RMD sufferers hum or moan while asleep during the episode. Some patients describe repetitive movements as relaxed and are only occasionally awakened by episodes of RMD. Often, it is a couple of sufferers or parents who first recorded the symptoms. In addition, often couples or parents who lead patients seeking medical attention.
Motor symptoms
Symptoms of rhythmic movement disorders vary, but most sufferers share a common pattern of large muscle movement. Many sufferers exhibit consistent symptoms including:
- body wobble, in which the whole body is moved temporarily in the hands and knees.
- head banging, where the head forcibly moves toward the back and back.
- the head is scrolling, where the head is moved sideways while in the supine position.
Other less common muscle movements include:
- body roll, where the whole body will move sideways while in the supine position.
- leg rolling, in which one or both legs are moved sideways.
- banging legs, where one or both legs are moved towards the back and back.
- a combination of the above-mentioned symptoms
The majority of sufferers have symptoms that involve the head, and the most common symptoms are head banging. Typically, the head attacks the pillow or mattress near the frontal-parietal area. There is little reason for alarm on movement due to injury or brain damage due to rare movements. Some infants with diagnosed Costello syndrome have been observed to have a unique RMD episode that affects the tongue and other facial muscles, which are unusual areas exposed. Episodes usually last less than fifteen minutes and produce motions that range from 0.5 to 2 Hz. Muscle movements during REM sleep often twitch and occur together with normal sleep. The position of the body during sleep can determine which motor symptoms are displayed. For example, Anderson et al. reported that one individual showed a twisting motion throughout the body while sleeping on his side while showing a twisting motion of his head while sleeping on his back.
Sleep
Due to abnormal writhing, the patient's sleep patterns are often disturbed. This may be due to comorbidity of RMD with sleep apnea, which has been observed in some patients. Many find that their sleep is not refreshing and tired or stressed the next day, despite getting a full night's rest. However, other patients reported that their sleep patterns were rarely disturbed because of the episode of RMD and did not report too sleepy during the following day as recorded on the Epworth Drowsiness Scale. Thus, as can be seen, the effects and severity of RMD vary from person to person.
Brain activity
Rhythmic movement disturbances were observed using standard procedures for polysomnography, which included video recording, sleeping EEG, EMG, and ECG. The brain-monitoring device mentioned above eliminates the possibility of epilepsy as the cause. Other sleep-related disorders such as sleep apnea are ruled out by checking for patient breathing, airflow, and oxygen saturation. RMD patients often show no abnormal activity that is directly the result of a disorder in an MRI scan. The RMD episode is strongly associated with NREM sleep stage 2 and, in particular, K Complexes. In addition, there is a close relationship with Alpha waves that contain a complex mixture of K and cedar, regardless of the NREM stage at which RMD occurs. The occurrence of these two brainwave sets indicates that the disorder is associated with an "unstable level of alertness" throughout NREM sleep. It has been interesting to note that there is no EEG mark during or soon after intense rhythmic movements. After the episode, the normal EEG pattern returns. Functional MRI scans have shown that mesencephalon and pons may be involved in loss of motor control seen during episode RMD, which is similar to other motion disorders.
Episode
Short RMD episodes, lasting between 3 and 130 seconds. A rare case of constant RMD can take hours. The majority of RMD episodes usually occur just before or during sleep. Several cases have been reported on rhythmic movements during conscious activities such as driving. When it occurs in sleep, the RMD episode is more likely to occur during non-REM, stage 2 sleep. Approximately 46% of sleep RMD episodes occur only in non-REM sleep; 30% in non-REM and REM; and only 24% are strictly in REM sleep. Most patients are unresponsive during the episode and are unlikely to remember the movement that occurs when waking up. In some patients who also have sleep apnea, apnea episodes may soon be followed by symptoms similar to RMD, suggesting that episodes of apnea may trigger episodes of RMD. Similarly, current research suggests that external stimuli are not the cause of the RMD episode.
Maps Rhythmic movement disorder
Cause
The basic direct and pathophysiological causes of RMD are still unknown and can occur in children and adults who are perfectly or imperfectly healthy. A rare case of adult RMD has grown due to head trauma, stress, and herpes encephalitis. Family cases have been reported to suggest that there may be some genetic aspects to the disorder; However, to date, this explanation has not been tested directly. Because family incidence rates are still relatively low, it is believed that behavioral aspects can play a larger role in RMD than in family history and genetics. Many patients report no family history of the disorder. Another theory suggests that RMD is a learning behavior, stimulates itself to relieve tension and induce relaxation, similar to the tic movement. An alternative theory suggests that rhythmic movements help to develop a vestibular system in children, which can partly explain the high prevalence of RMD in infants. It has been seen that children with underdeveloped vestibular systems benefit from performing RMD-like movements that stimulate the vestibular system.
Development
Sleep-related movements are commonly seen in children, especially infants. However, the majority of these movements stop at the age of the children. Approximately 66% of infants from 9 months showed symptoms similar to RMD compared to only 8% of children aged 4 years. This disorder is closely related to mental retardation or other psychiatric disorders such as Autism. More recent studies have shown there is a strong relationship between prolonged RMD and ADHD.
Diagnosis
The diagnosis of rhythmic movement disorder is made on the basis of exceptions where other motion-related disorders are systematically ruled out. Therefore, a thorough clinical evaluation is required. Often, the disturbance is not severe enough to warrant this process and so RMD is not often diagnosed unless there are very disturbing or disabling symptoms. Many patients do not seek treatment for RMD directly and most seek professional help to reduce symptoms that affect sleep. To complicate this problem, many sufferers are often misdiagnosed with Restless Leg Syndrome or sleep apnea or a combination of both. The rhythmic movement disturbance differs from Restless Legs Syndrome in RMD which involves muscle contraction without impetus or discomfort to provoke the movement. In addition, 80-90% of patients with Restless Leg Syndrome show periodic leg movements as observed in polysomnograms, which are not common in RMD patients. Rhythmic movement disorders can also have symptoms that overlap with epilepsy. However, the use of polysomnogram may help distinguish one interference from other disorders because RMD involves movement in REM and NREM sleep, which is unusual for seizures. In addition, patients can usually stop motion on demand, unlike the motion observed in epilepsy. Other movement disorders such as Parkinson's disease, Huntington's disease, ataxia, and dystonia differ from RMD as it occurs mainly during waking and sleep deprivation, whereas the RMD episodes occur around or around sleep.
Treatment
Medication
Drugs are often not necessary in children because the symptoms usually subside spontaneously at the age of the children. However, since this disorder can affect conscious behavior, many adults who continue to suffer from RMD may seek treatment. Benzodiazepines or tricyclic antidepressants have been considered a therapeutic option in managing the disorder. Childhood and adolescent RMDs respond well to low doses of clonazepam. Prescription drugs such as ropinirole or pramipexole given to patients with restless leg syndrome do not show clinical improvement in many patients with RMD.
Non-medication
Treatment of sleep apnea through positive air pressure devices (CPAP) continues to show dramatic improvement in apnea and virtually resolve symptomatic resolution of RMD. Behavioral interventions can alleviate some RMD symptoms and movements. In such therapy, the patient is required to perform movements such as RMD during the day in a slow and methodical way. Thus, patients come from the full rhythmic movements they experience during sleep. Such behavioral training has been proven to be sleeping, and the strength of RMD movements is reduced or eliminated. Hypnosis and sleep restriction have been used in some cases with good effect.
References
External links
Source of the article : Wikipedia
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