Remitting REM sleep behavior disorder as the initial sign of multiple sclerosis

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Giuseppe Plazzi1, Pasquale Montagna

  • 1Institute of Clinical Neurology, University of Bologna, Bologna, Italy. plazzi@neuro.unibo.it

Sleep Medicine
|November 1, 2003
PubMed

We report a case of a 25-year-old woman presenting with a 6 month history of REM sleep behavior disorder (RBD), confirmed by video-polysomnography. A brain MRI disclosed multiple cerebral periventricular and pontine non-gadolinium-enhancing hyperintensities and CSF isoelectric focusing showed oligoclonal bands, consistent with a diagnosis of probable multiple sclerosis (MS). RBD episodes disappeared after ACTH treatment, but clinical relapses and MRI follow-up confirmed the diagnosis of MS. Although RBD has been described in association with MS, it has not been reported as a heralding sign, nor related to MS brainstem lesion. Our case emphasizes the value of RBD as a clinical tell-tale sign: when isolated RBD appears in a young subject, brain-imaging studies and long-term follow-up are warranted.

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