Parasomnia overlap disorder sleepwalkingsleep terrorsREM sleep behaviour disorder

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A group of 33 patients has been reported with polysomnogram-documented sleepwalking, sleep terrors, and REM sleep behaviour disorder. (5) The mean age was 34 years, the mean age of parasomnia onset was 15 years (range:1-66 years), and 70 per cent were male. An idiopathic subgroup ( N = 22) had a significantly earlier mean age of parasomnia onset (9 years) than a symptomatic subgroup (27 years) (N = 11) whose parasomnia began with either a neurological disorder (N = 6), nocturnal paroxysmal atrial fibrillation (N = 1), post-traumatic stress disorder/major depression (N = 1), chronic ethanol/amphetamine abuse and withdrawal (N = 1), or mixed disorders (schizophrenia, brain trauma, substance abuse (N = 2)). The rate of psychiatric disorders was not elevated; group scores on various psychometric tests were not elevated. Forty-five per cent (N = 15) had previously received psychological or psychiatric therapy for their parasomnia, without benefit. Treatment, usually with clonazepam, was effective for most patients. The natural history is not yet known.

An experimental animal model is applicable to combined sleepwalking/sleep terrors/REM sleep behaviour disorder (as cited (36)): cats who receive kainic acid injections into the midbrain display 'hallucinatory-type' behaviours in wakefulness, with complete unresponsiveness to environmental stimuli, which are identical to the oneiric behaviours displayed in the cat model of REM sleep behaviour disorder.

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