Objective: To explore the prevalence of REM sleep behavior disorder (RBD) and define the brainstem structures likely to be involved in its pathogenesis in patients with brainstem lesions on magnetic resonance imaging (MRI).
Methods: Sixty-two patients with definite brainstems lesions on brain MRI were recruited from Neurology Department, Peking Union Medical College Hospital. And 66 gender-and-age-matched healthy subjects were included as controls. RBD screening questionnaire (RBDSQ) was provided. All patients fulfilling clinical criteria for RBD underwent a two-night polysomnography (PSG) with synchronized audio-visual recording and the evaluations of Zung self-rating depression scale (SDS) and Zung self-rating anxiety scale (SAS).
Results: The brainstem group had a mean age of 43±16 years (range, 18-65) while the controls a mean age of 41±13 years (range, 18-65). In brainstem group, SDS scores were 38±4 (range, 35-44); SAS scores 43.0±5.8 (range, 36-49). In controls, SDS scores were 64±6 (range, 59-68); SAS scores 69.5±2.1 (range, 68-71). Five patients in the brainstem group and two in the control group fulfilling the clinical criteria for RBD were confirmed after PSG. All five patients had focal lesion on pontine tegmentum. Treatment with clonazepam at bedtime completely resolved the RBD symptoms.
Conclusion: RBD is common in patients with brainstem lesions. And its definite diagnosis is based upon clinical symptoms and PSG examination.