Abstract
REM sleep behavior disorder (RBD) has been described in the setting of some paraneoplastic neurological disorders and autoimmune diseases. Reports include small case series and single reports suggesting that the association is not strong or that it has been underestimated because physicians paid little attention to RBD features when patients presented with acute or subacute disabling neurological symptoms (e.g., mental confusion, seizures, paralysis, ataxia) linked to the underlying condition. RBD confirmed by polysomnography has been described in the paraneoplastic syndromes anti-Ma2 encephalitis and cerebellar degeneration and in the limbic encephalitis associated with LGI1 antibodies. In most of the cases reported, RBD symptoms were not prominent, but the associations reflect that the brain stem (damaged in the anti-Ma2 encephalitis), limbic system (the amygdala is impaired in the anti-LGI1 limbic encephalitis), and the cerebellum (severe Purkinje cell loss in paraneoplastic cerebellar degeneration) play a role in the pathogenesis of RBD. Some patients with Morvan syndrome present with agrypnia excitata, a form of status dissociatus. RBD is present in some autoimmune diseases including narcolepsy (probably due to lack of hypocretin input to the brain stem nuclei that regulate REM sleep) and multiple sclerosis (when plaques are located in the pontine tegmentum). REM sleep without atonia has been described in the acute phase of Guillain-Barré syndrome in some patients. RBD is very common in the anti-IgLON5 disease (a condition of probable autoimmune origin linked to neuronal antibodies and tau deposits in the brain, with a strong HLA link) in association with purposeful behaviors in NREM sleep, disorganized sleep architecture, laryngeal stridor, and obstructive apnea.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Höftenberfg R, Rosenfeld M, Dalmau J. Update on neurological paraneoplastic syndromes. Curr Opin Oncol. 2015;27:489–95.
Graus F, Dalmau J. Paraneoplastic neurological syndromes: diagnosis and treatment. Curr Opin Neurol. 2007;20:732–7.
Silber MH. Autoimmune sleep disorders. Handb Clin Neurol. 2016;133:317–26.
Compta Y, Iranzo A, Santamaria J, Casamitjana R, Graus F. REM sleep behavior disorder and narcolpetic features in anti-Ma2 encephalitis. Sleep. 2007;30:767–9.
Adams C, McKeon A, Silber MH, Kumar R. Narcolepsy, REM sleep behavior disorder, and supranuclear gaze palsy associated with Ma1 and Ma2 antibodies and tonsillar carcinoma. Arch Neurol. 2011;68:521–4.
Dauvilliers Y, Bauer J, Rigau V. Hypothalamic immunopathologyin anti-Ma-associated diencephalitis with narcolepsy-cataplexy. Hypothalamic immunopathology in anti-Ma-associated diencephalitis with narcolepsy-cataplexy. JAMA Neurol. 2013;70:1305–10.
Irani SR, Alexander S, Waters P, et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan’s syndrome and acquired neuromyotonia. Brain. 2010;133:2734–274.
Iranzo A, Graus F, Clover L, et al. Rapid eye movement sleep behavior disorder and potassium channel antibody–associated limbic encephalitis. Ann Neurol. 2006;59:178–82.
Cornellius JR, Pittock SJ, McKeom A, et al. Sleep manifestations of voltage-gated potassium channel complex autoimmunity. Arch Neurol. 2011;68:733–8.
Tezer I, Erdener E, Sel CC, Mendikanova L, Sagy S, Topcuoglu M. Daytime polysomnography recording in LIG1-related limbic encephalitis. Arch Neurol. 2012;69:145–6.
Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Ann N Y Acad Sci. 2015;1338:94–114.
Lugaresi E, Provini F. Agrypnia excitata: clinical features and pathophysiological implications. Sleep Med Rev. 2001;5:313–22.
Liguori R, Vincent A, Clover L, Avoni P, Plazzi G, Cortelli P, et al. Morvan’s syndrome: peripheral and central nervous system and cardiac involvement with antibodies to voltage-gated potassium channels. Brain. 2001;124:2417–26.
Guaraldi P, Calandra-Buonaura G, Terlizzi R, et al. Oneiric stupor: the peculiar behaviour of agrypnia excitata. Sleep Med. 2011;12:S64–7.
Provini P, Marconi M, Amadori M, et al. Morvan chorea and agrypnia excitata: when video-polysomnographic recording guides the diagnosis. Sleep Med. 2011;12:1041–3.
Antelmi E, Ferri R, Iranzo A, et al. From state dissociation to status dissociatus. Sleep Med Rev. 2016;28:1–13.
Cardoso Vale T, Bizari Fernanes do Prado L, Fernnades Do Prado G, Grazian Povoas Barsittini O, Pedroso JL. Rapid eye movement sleep behavior disorder in paraneoplastic cerebellar degeneration: improvement with immunotherapy. Sleep. 2016;39:117–20.
Iranzo A, Santamaria J, Rye DB, et al. Characteristics of idiopathic REM sleep behavior disorder and that associated with MSA and PD. Neurology. 2005;65:247–52.
Iranzo A, Muñoz E, Santamaría J, Vilaseca I, Milà M, Tolosa E. REM sleep behavior disorder and vocal cord paralysis in Machado-Joseph disease. Mov Disord. 2003;18:1179–83.
Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfield MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10:63–74.
Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7:1091–8.
Stamelou M, Plazzi G, Lugaresi E, Edwards MJ, Bathia KP. The distinct movement disorder in anti-NMDA receptor encephalitis may be related to status dissociates: a hypothesis. Mov Disord. 2012;27:1360–3.
Coban A, Kücükali CI, Yalcinkaya N, et al. Evaluation of incidence and clinical features of antibody-associated autoimmune encephalitis mimicking dementia. Behav Neurol. 2014;2014:935379.
Schenck CH, Mahowald MW. Motor dyscontrol in narcolepsy: rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder. Ann Neurol. 1992;32:3–10.
Gomez-Choco M, Iranzo A, Blanco Y, Graus F, Santamaria J, Saiz A. Prevalence of restless legs syndrome and REM sleep behavior disorder in multiple sclerosis. Mult Scler. 2007;13:805–8.
Plazzi G, Montagna P. Remitting REM sleep behaviour disorder as the initial sign of multiple sclerosis. Sleep Med. 2002;3:437–9.
Tippmann-Peikert M, Boeve BF, Keegan BM. REM sleep behavior disorder initiated by acute brainstem multiple sclerosis. Neurology. 2006;66:1277–9.
Cochen V, Arnulf I, Demeret S, et al. Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome. Brain. 2005;128:2535–45.
Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep. 1986;9:293–308.
Sabater L, Gaig C, Gelpi E, et al. A novel non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder associated with antibodies to IgLON5: a case series, characterisation of the antigen, and post-mortem study. Lancet Neurol. 2014;13:575–86.
Högl B, Heidbreder A, Santamaria J, Graus F, Poewe W. IgLON5 autoimmunity and abnormal behaviours during sleep. Lancet. 2015;385:1590.
Simabukuro MM, Sabater L, Adoni T, et al. Sleep disorder, chorea, and dementia associated with IgLON5 antibodies. Neurol Neuroimmunol Neuroinflamm. 2015;e136:2.
Montojo MT, Piren V, Benkhadra F, et al. Mimicking progressive supranuclear palsy and causing Tako-Tsubo syndrome: a case report on IgLON5 encephalopathy [abstract]. Mov Disord. 2015;30(Suppl 1):710.
Brüggemann N, Wandinger KP, Gaig C, et al. Dystonia, lower limb stiffness, and upward gaze palsy in a patient with IgLON5 antibodies. Mov Disord. 2016;31:762–4.
Schröder JB, Melzer N, Ruck T, et al. Isolated dysphagia as initial sign of anti-IgLON5 syndrome. Neurol Neuroimmunol Neuroinflamm. 2016 Nov 22;4(1):e302.
Haitao R, Yingmai Y, Yan H, et al. Chorea and parkinsonism associated with autoantibodies to IgLON5 and responsive to immunotherapy. J Neuroimmunol. 2016;300:9–10.
Zhang W, Niu N, Cui R. Serial 18F-FDG PET/CT findings in a patient with IgLON5 encephalopathy. Clin Nucl Med. 2016;41:787–8.
Gelpi E, Höftberger R, Graus F, et al. Neuropathological criteria of anti-IgLON5-related tauopathy. Acta Neuropathol. 2016;132:531–43.
Gaig C, Graus F, Compta Y, et al. Clinical manifestations of the anti-IgLON5 disease. Neurology. 2017;88:1736–43.
Cagnin A, Mariotto S, Fiorini M, et al. Microglial and neuronal TDP-43 pathology in anti-IgLON5-related taupathy. J Clin Alzheimer’s Dis. 2017;59:13–20.
Honorat JA, Lomorowski L, Josephs KA, et al. IgLON5 antibody. Neurological accompaniments and outcomes in 20 patients. Neurol Neuroimmunol Neuroinflamm. 2017;4(5):e385. https://doi.org/10.1212/NXI.0000000000000385.
Bahtz R, Teegen B, Borowski K, et al. Autonatibodies against IgLON5: two new cases. J Neuroimmunol. 2014;275:8.
Bonello M, Jacob A, Ellul MA, et al. IgLON5 disease responsive to immunotherapy. Neurol Neuroimmunol Neuroinflamm. 2017;4(5):e383. https://doi.org/10.1212/NXI.0000000000000383.
Sabater L, Planagumà J, Dalmau J, Graus F. Cellular investigations with human antibodies associated with the anti-IgLON5 syndrome. J Neuroinflammation. 2016 Sep 1;13(1):226. https://doi.org/10.1186/s12974-016-0689-1.
Acknowledgment
To Dr. Carles Gaig for reviewing the anti-IgLON5 disease section of this chapter and providing the figure.
Note Added in Proof: RBD has also been described in the setting of subjects with systemic autoimmune conditions such as Behcet’s disease, Sjoegren’s syndrome and rheumatoid arthritis. However, these patients also presented the cardinal symptomatology of the synucleinopathies, namely parkinsonism and cognitive impairment. (1) Fulong X, Jun Z, Waner W, Xuehua W, Wei Z, Liyue X, Fang H. A case report of REM sleep behavior disorder, Bechet’s disease, Sjoegren’s syndrome and cognitive dysfunction. BMC Rheumatology 2018 (in press). (2) Cosentino FII, Distefano A, Plazzi G, Schenck CH, Ferri R. A case of REM sleep behavior disorder, narcolepsy-cataplexy, parkinsonism and rheumatoid arthritis. Behavioral Neurology; 2014; 2014:572931. doi:10.1155/2014/572931.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Iranzo, A. (2019). RBD Associated with Paraneoplastic Neurological Syndromes and Autoimmune Disorders. In: Schenck, C., Högl, B., Videnovic, A. (eds) Rapid-Eye-Movement Sleep Behavior Disorder. Springer, Cham. https://doi.org/10.1007/978-3-319-90152-7_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-90152-7_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90151-0
Online ISBN: 978-3-319-90152-7
eBook Packages: MedicineMedicine (R0)