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REM and NREM Sleep Parasomnia in Anti-NMDA Receptor Encephalitis

Luis Ribeiro1, Dimitri Psimaras1, Raphael Vollhardt1

  • 1From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France.

Neurology(R) Neuroimmunology & Neuroinflammation
|June 25, 2024
PubMed
Abstract

Insights

Anti-N-methyl-d-aspartate receptor antibody encephalitis (anti-NMDARe) can cause REM sleep behavior disorder. Video-polysomnography helps diagnose these parasomnias, which may improve with gabapentin and clonazepam.

Area of Science:

  • Neurology
  • Sleep Medicine
  • Immunology

Background:

  • Anti-N-methyl-d-aspartate receptor antibody encephalitis (anti-NMDARe) is a severe autoimmune disorder.
  • Clinical manifestations include cognitive deficits, psychosis, seizures, and movement disorders.
  • Abnormal behaviors during REM sleep have not been previously documented in anti-NMDARe.

Purpose of the Study:

  • To describe REM sleep parasomnias in patients with anti-NMDARe.
  • To evaluate the diagnostic utility of video-polysomnography in these cases.
  • To assess the treatment response for these sleep disturbances.

Main Methods:

  • Utilized video-polysomnography for patient monitoring.
  • Included multiple sleep latency tests and extended bed rest.
  • Documented specific parasomnias observed during sleep.

Main Results:

  • Two patients with anti-NMDARe exhibited parasomnias, including REM sleep behavior disorder.
  • Observed continuous, goal-directed quiet gesturing during N2/R sleep stages.
  • Parasomnia symptoms improved with gabapentin and clonazepam treatment.

Conclusions:

  • Video-polysomnography is crucial for differentiating anti-NMDARe-associated parasomnias from seizures or movement disorders.
  • Accurate diagnosis facilitates appropriate therapeutic interventions.
  • Gabapentin and clonazepam show promise in managing these REM sleep disturbances.

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