Rapid eye movement sleep behavior disorder or epileptic seizure during sleep? A video analysis of motor events

To compare the motor semiology of sleep behavior disorder (RBD) during rapid eye movement (REM) with epileptic seizures in non-REM and REM sleep.

We analyzed the types and frequency of motor events from videos of patients with RBD (n = 15, mean age 64.8 years, 179 motor episodes) and patients with epilepsy (n = 15, mean age 34.4 years, 87 sleep-related epileptic seizures including 34 during REM sleep).

Patients with sleep-related epileptic seizures more often woke up abruptly (28% vs. 0.3%), raised head/trunk (31% vs. 1.6%), opened their eyes (89% vs. 5%), had whole body movements (74% vs. 14%) or dystonic posturing (29% vs. 1.3%), manipulated objects in their environment (44% vs. 3.9%), as if emerging from sleep with ictal automatisms, and sniffed, coughed, or breathed differently during motor events. In contrast, RBD patients more often remained lying down with closed eyes (99% vs. 78%) as if still asleep, with non-stereotyped jerky movements (42% vs. 8%) and outward-directed behaviors (14% vs. 2%) than patients with epilepsy. There were no differences in violent behaviors and vocalizations between groups. Comparison with subgroups of REM or non-REM sleep seizures yielded many similar findings.

These different motor patterns discriminate between RBD events and sleep-associated seizures, and could be used as an aid to differential diagnosis.