A case of differential diagnosis of REM sleep behavior disorder and sleep-related hypermotor epilepsy

Aim. To describe a clinical case of differential diagnostics of motor phenomena during sleep. Materials and methods. Patient B., 37 years old. Visit to a somnologist at the University Clinic. Complaints were mainly made by the patient’s wife, since the patient himself does not remember these episodes. According to the wife, sudden sweeping movements of the arms and legs, incoherent speech are noted during sleep, then the patient gets up, can grab his hands, behaves aggressively, shifts things. These complaints have been noted for more than 10 years, with a gradual worsening of symptoms. A neurologist at the place of residence suggested a possible epileptic nature of these episodes,but no further examination was carried out. Results. From a semiological point of view, motor phenomena during sleep can imitate epileptic seizures, parasomnias, rapid eye movement behavior disorders, and normal sleep motor phenomena such as fragmentary sleep myoclonus, periodic limb movements, bruxism, etc. A differential diagnostic search is provided, a comparative characteristic of motor phenomena during sleep and wakefulness is given, as well as a scale of frontal epilepsy and parasomnia, which can help the doctor in making the correct diagnosis. Conclusion. Conducting a comprehensive examination of the patient and clarifying the clinical diagnosis made it possible to choose the correct management tactics, avoid unjustified prescription of antiepileptic drugs, and reduce emotional stress in the family due to the ambiguity of the manifestations of night motor phenomena. The established clinical diagnosis allows monitoring the patient in terms of the possible debut of a neurodegenerative disease.