RBD in Childhood and Adolescence

  • Garima Shukla
  • Suresh Kotagal
  • Carlos H. SchenckEmail author


While REM sleep behavior disorder (RBD) is typically observed among older adults, with characteristic clinical and polysomnographic features and risk for future neurodegenerative disease in the majority, it has also been reported among children and adolescents. The clinical presentation, associated conditions, and clinical course have not been studied in detail in childhood, however. Insights into the pathogenesis, clinical manifestations, diagnosis and directions for future research related to childhood-onset RBD and its polysomnographic signature, REM sleep without atonia (RSWA), are presented. An illustrative case report has been included, and details of published case reports and case series have been tabulated. Differential diagnosis and clues for recognition of RBD among the young are also discussed.


Childhood RBD Polysomnography REM without atonia Narcolepsy Brainstem tumors Antidepressant medications 


  1. 1.
    Partinen M, Hublin C. Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. Philadelphia: WB Saunders; 2000. p. 558–79.Google Scholar
  2. 2.
    Navalet Y, Benoit O, Bouard G. Nocturnal sleep organization during the first months of life. Electroencephalogr Clin Neurophysiol. 1982;54:71–8.CrossRefGoogle Scholar
  3. 3.
    Blumberg MS, Marques HG, Lida F. Twitching in sensorimotor development from sleeping rats to robots. Curr Biol. 2013;23:R532–7.CrossRefGoogle Scholar
  4. 4.
    Khazipov R, Sirota A, Leinekugel X, et al. Early motor activity drives spindle bursts in the developing sensorimotor cortex. Nature. 2004;432:758–61.CrossRefGoogle Scholar
  5. 5.
    Boeve BF, Silber MH, Saper CB, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain. 2007;130(Pt 11):2770–88.CrossRefGoogle Scholar
  6. 6.
    Corner MA, Schenck CH. Perchance to dream? Primordial motor activity patterns in vertebrates from fish to mammals: their prenatal origin, postnatal persistence during sleep, and pathological re-emergence during REM sleep behavior disorder. Neurosci Bull. 2015;31(6):649–62.CrossRefGoogle Scholar
  7. 7.
    Mascetti GG. Unihemispheric sleep and asymmetrical sleep: behavioral, neurophysiological and functional perspectives. Nat Sci Sleep. 2016;8:221–38.CrossRefGoogle Scholar
  8. 8.
    Grigg Damberger MM. The visual scoring of sleep in infants 0 to 2 months of age. J Clin Sleep Med. 2016;12(3):429–45.CrossRefGoogle Scholar
  9. 9.
    Jennum P, Christensen JAE, Zoetmulder M. Neurophysiological basis of rapid eye movement behavior disorder: informing future drug development. Nat Sci Sleep. 2016;8:107–20.CrossRefGoogle Scholar
  10. 10.
    Schenck CH, Hurwitz TD, Mahowald MW. REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature. J Sleep Res. 1993;2:224–31.CrossRefGoogle Scholar
  11. 11.
    Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behavior disorder: demographic, clinical and laboratory findings in 93 cases. Brain. 2000;123:331–9.CrossRefGoogle Scholar
  12. 12.
    Sforza E, Krieger J, Petiau C. REM sleep behavior disorder: clinical and physiopathological findings. Sleep Med Rev. 1997;1:57–69.CrossRefGoogle Scholar
  13. 13.
    De Barros-Ferreira M, Chodkiewicz JP, Lairy GC, Salzarulo P. Disorganized relations of tonic and phasic events of REM sleep in a case of brain-stem tumour. Electroencephalogr Clin Neurophysiol. 1975;38:203–7.CrossRefGoogle Scholar
  14. 14.
    Schenck CH, Bundlie SR, Smith SA, Ettinger MG, Mahowald MW. REM behavior disorder in a 10 year old girl and aperiodic REM and NREM sleep movements in an 8 year old brother. Sleep Res. 1986;15:162.Google Scholar
  15. 15.
    Sheldon SH, Jacobsen J. REM-sleep motor disorder in children. J Child Neurol. 1998;13(6):257–60.CrossRefGoogle Scholar
  16. 16.
    Thirumalai SS, Shubin RA, Robinson R. Rapid eye movement sleep behavior disorder in children with autism. J Child Neurol. 2002;17:173–8.CrossRefGoogle Scholar
  17. 17.
    Blaw ME, Leroy RF, Steinberg JB, Herman J. Hereditary quivering chin and REM behavioral disorder. Ann Neurol. 1989;26:471.Google Scholar
  18. 18.
    Herman JH, Blaw ME, Steinberg JB. REM behavior disorder in a two year old male with evidence of brainstem pathology. Sleep Res. 1989;18:242.Google Scholar
  19. 19.
    Henriques-Filho PS, Sergio PA, Pratesi R. Sleep apnea and REM sleep behavior disorder in patients with Chiari malformations. Arq Neuropsiquiatr. 2008;66:344–9.CrossRefGoogle Scholar
  20. 20.
    Trajanovic NN, Voloh I, Shapiro CM, Sandor P. REM sleep behaviour disorder in a child with Tourette’s syndrome. Can J Neurol Sci. 2004;31(04):572–5.CrossRefGoogle Scholar
  21. 21.
    Nevsimalova S, Prihodova I, Kemlink D, Lin L, Mignot E. REM behavior disorder (RBD) can be one of the first symptoms of childhood narcolepsy. Sleep Med. 2007;8(7–8):784–6.CrossRefGoogle Scholar
  22. 22.
    Turner R, Allen WT. REM sleep behavior disorder associated with narcolepsy in an adolescent: a case report. Sleep Res. 1990;19:302.Google Scholar
  23. 23.
    Lloyd R, Tippmann-Peikert M, Slocumb N, Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med. 2012;8(2):127–31.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Rye DB, Johnston LH, Watts RL, Bliwise DL. Juvenile Parkinson’s disease with REM sleep behavior disorder, sleepiness, and daytime REM onset. Neurology. 1999;53:868–70.CrossRefGoogle Scholar
  25. 25.
    Teman PT, Tippmann-Piekert M, Silber MH, et al. Idiopathic rapid eye movement disorder: associations with antidepressants psychiatric diagnoses, and other factors in relation to age of onset. Sleep Med. 2009;10:60–5.CrossRefGoogle Scholar
  26. 26.
    Schenck CH, Boyd JL, Mahowald MW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep. 1997;20:972–81.CrossRefGoogle Scholar
  27. 27.
    American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014.Google Scholar
  28. 28.
    Kotagal S. Rapid eye movement sleep behavior disorder during childhood. Sleep Med Clin. 2015;10:163–7.CrossRefGoogle Scholar
  29. 29.
    Broughton RJ. Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in “dreaming sleep”. Science. 1968;159(3819):1070–8.CrossRefGoogle Scholar
  30. 30.
    Haupt M, Sheldon SH, Loghmanee D. Just a scary dream? A brief review of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder. Pediatr Ann. 2013;42(10):211–6.CrossRefGoogle Scholar
  31. 31.
    Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL and Vaughn BV for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Version 2.3. Darien: American Academy of Sleep Medicine; 2016.
  32. 32.
    Frauscher B, Iranzo A, Gaig C, et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep. 2012;35(6):835–47.CrossRefGoogle Scholar
  33. 33.
    Parish JM. Violent dreaming and antidepressant drugs: or how paroxetine made Me dream that I was fighting Saddam Hussein. J Clin Sleep Med. 2007;3(5):529–31.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Postuma RB, Gagnon JF, Tuineaig M, et al. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? Sleep. 2013;36(11):1579–85.CrossRefGoogle Scholar
  35. 35.
    Starkstein S, Gellar S, Parlier M, Payne L, Piven J. High rates of parkinsonism in adults with autism. J Neurodev Disord. 2015;7(1):29.CrossRefGoogle Scholar
  36. 36.
    Croen LA, Zerbo O, Qian Y, Massolo ML, Rich S, Sidney S, Kripke C. The health status of adults on the autism spectrum. Autism. 2015;19(7):814–23.CrossRefGoogle Scholar
  37. 37.
    Fujita-Jimbo E, Yu Z-L, Li H, Yamagata T, Mori M, et al. Mutation in Parkinson disease-associated, G-protein-coupled receptor 37 (GPR37/PaelR) is related to autism spectrum disorder. PLoS One. 2012;7(12):e51155.CrossRefGoogle Scholar
  38. 38.
    Schecklmann M, Schenck C, Taurines R. A systematic review on olfaction in child and adolescent psychiatric disorders. J Neural Transm. 2013;120(1):121–30.CrossRefGoogle Scholar
  39. 39.
    Jarick I, Volckmar A-L, Putter C. Genome-wide analysis of rare copy number variations reveals PARK2 as a candidate gene for attention-deficit/hyperactivity disorder. Mol Psychiatry. 2014;19:115–21.CrossRefGoogle Scholar
  40. 40.
    Hansen FH, Skjørringe T, Yasmeen S, et al. Missense dopamine transporter mutations associate with adult parkinsonism and ADHD. J Clin Invest. 2014;124:3107–20.CrossRefGoogle Scholar
  41. 41.
    Schormair B, Zhao C, Bell S, et al. Identification of novel risk loci for restless legs syndrome in genome-wide association studies in individuals of European ancestry: a meta-analysis. Lancet Neurol. 2017;16(11):898–907.CrossRefGoogle Scholar
  42. 42.
    Antelmi E, Pizza F, Vandi S, et al. The spectrum of REM sleep-related episodes in children with type 1 narcolepsy. Brain. 2017;140:1669–79.CrossRefGoogle Scholar
  43. 43.
    Bin-Hasan S, Videnovic A, Maski K. Nocturnal REM sleep without atonia is a diagnostic biomarker of pediatric narcolepsy. J Clin Sleep Med. 2018;14(2):245–52.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Garima Shukla
    • 1
    • 2
  • Suresh Kotagal
    • 3
  • Carlos H. Schenck
    • 4
    Email author
  1. 1.Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Division of Neurology-Epilepsy and Sleep, Department of MedicineQueen’s University and Kingston General HospitalKingstonCanada
  3. 3.Sleep Disorders Center, Mayo ClinicRochesterUSA
  4. 4.Minnesota Regional Sleep Disorders Center, and Departments of PsychiatryHennepin County Medical Center and University of Minnesota Medical SchoolMinneapolisUSA

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