![]() ![]() RBD was observed in narcoleptic patients even before its first recognition as a clinical entity by Schenck et al. The time lag between the occurrence of RBD and synucleinopathy can span from one to many years or decades. Thus, RBD often heralds synucleinopathies, such as Parkinson disease, Lewy body dementia, and multiple system atrophy. Patients initially diagnosed with idiopathic RBD often later develop other neurological signs including parkinsonism (most frequently), orthostatic hypotension, anosmia, and cognitive impairment. RBD may be idiopathic or symptomatic and both forms are strongly associated with neurodegerative diseases finally, RBD can be iatrogenic. Patients predisposed to RBD and later parkinsonism might be susceptible to a variety of triggers that, in our patient, might have been represented by a possible latent autoimmune process leading to the development of narcolepsy with cataplexy and rheumatoid arthritis, later.įirst described in 1986, rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by repeated episodes of dream enactment behavior and REM sleep without atonia (RWA), evident during polysomnographic recording and manifested as increased phasic or tonic muscle activity on electromyogram channels. ![]() Moreover, a late development of parkinsonism and the occurrence of rheumatoid arthritis were detected and clinically and instrumentally characterized. The patient was found to present for almost two decades, in addition to RBD, also narcolepsy. A 78-year-old male patient in whom RBD was first diagnosed was followed-up by clinical examination, video-polysomnography, multiple sleep latency test, cerebral magnetic resonance imaging, and dopamine transporter imaging by single-photon emission computerized tomography. A patient is reported in whom signs and symptoms of REM sleep behavior disorder (RBD) and narcolepsy have been associated for almost two decades with a late development of parkinsonism and rheumatoid arthritis. ![]()
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