PMC3615167_01
Example (10 seconds) of faulty regulation of motor activity in REM sleep indicating RBD.. Note: The time line of Fig. 1 is 10 s. Legend top to bottom: EOG vert./hor.=electrooculogram:eye movements vertical or horizontal; F4, F3=frontal electrodes right and left; C4, C3=central electrodes right and left; O2, O1=occipital electrodes right and left; EMG electromyogram=muscle activity; ment. subment.=mental, submental; EMG tib li, tib re.=left and right muscle activity of lower leg (mm. tibiali); Atmg.=breathing; nas.=nasal; thorak.=thoracic; Schnarchmikro=snoring; EKG=ECG; SAO2=O2-saturation. Note the beginning of muscle activity in the form of twitches, moving to almost continuous muscle activity, first in the right m. tibialis anterior, then spreading to the left one, too. On the EOG, rapid eye movements are clearly visible, indicating ongoing REM. In the last third of the episode some muscle activity spreads to head muscles as well. No muscle activity in mental and submental muscles during the whole event; that is, these muscles maintained REM-atonia.
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Arnulf,). As is typical in RBD, the muscle activity is not continuous, but consists of single twitches with a duration of 70-100 ms (note the single twitches in the first 3 seconds of EMG in the right m. tibialis in Fig. 1) which increase in frequency until merging into near-continuous muscle activity. In this example (see Fig. 1), the muscle activity spreads to the mm. frontales (F3-A1, F4-A2 and EOG vert. in the 7th to 9th second) and ends in a microarousal.
PSG results before initiating clonazepame and pramipexole treatment.. Note: from top to bottom: 1, hypnogram showing the NREM-REM-cycles and interruptions thereof; 2, display of arousals; 3, overall leg movements; 4, periodic leg movements. Notice heavy fragmentation of REM sleep periods, often correlated to periodic limb movements. In NREM there is a long cluster of PLMs.
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Furthermore, the patient showed moderate PLM during sleep (see Fig. 2).