Sleep Related Rhythmic Movement Disorder in older children and adults and their association with comorbid conditions - experience from two centres and literature review

Sleep related rhythmic movement disorders (SRRMD) are highly prevalent among infants and children and tend to disappear into adolescence and adulthood. However, few reports have identified patients who had rhythmic movements at wake-sleep transition persisting into adulthood. This is a case series of SRRMD diagnosed on video-polysomnography from retrospective chart review of patients, who were 6 years or older, seen in Sleep Neurology clinics in two centres by the senior author, over a 10 years period. In addition, an updated review of all papers published on the topic, since year 2000 is being reported. A total of nine patients (2 females) with SRRMD were included in this series with age ranging between 9 and 62 years. Five patients had comorbid primary sleep disorders and four others had associated neurodevelopmental disorders. Association with other primary sleep disorders like sleep apnea and restless legs syndrome and relief with treatment of the latter, has been highlighted.

Sleep-related rhythmic movement disorder in children: a mini-review

Sleep-related rhythmic movement disorder (SRRMD) occurs in both infants and children. This disorder rarely occurs or persists in adolescence or adulthood. Rhythmic movement during sleep in children is often asymptomatic and considered a benign condition. It is classified as SRRMD when movement significantly disrupts sleep, results in daytime functional impairment, or causes self-inflicted body injury. Several studies have demonstrated that SRRMD occurs in all sleep stages. Few studies have investigated rhythmic movement disorder (RMD) in children. SRRMD is a clinical diagnosis supported by home video recordings. When the clinical history is insufficient to provide a definitive diagnosis of SRRMD, and other sleep-related conditions or seizure disorders are suspected, video-polysomnography is indicated. There are currently no clinical guidelines for treating SRRMD.

Atypical head banging developed in teens persisting into adulthood as sleep-related rhythmic movement disorder

Head banging is one subtype of sleep-related rhythmic movement disorder, characterized by stereotyped, repetitive rhythmic movements, such as lifting the head or entire upper body, banging the frontal area hard on the pillow, or slamming the occiput against a headboard. An atypical form of head banging with punching or slapping the head with a hand is extremely rare, with only 4 such cases reported so far. Herein, we present a young adult male who, since his early teens, has had atypical head banging, also called head-slapping, and discuss the neuropsychological and polysomnographic findings and review the literature.

CITATION

Ji K-H, Kang M-R, Kim SJ. Atypical head banging developed in teens persisting into adulthood as sleep-related rhythmic movement disorder. J Clin Sleep Med. 2023;19(5):999-1001.

Images: Rhythmic movement disorder in a normal developing child with obstructive sleep apnea

CITATION

Children can exhibit a plethora of strange movements during sleep. Asymptomatic rhythmic movements of the head, neck, and trunk can be normal. When these interfere with sleep or cause self-injury, it is pathologic and termed rhythmic movement disorder.

CITATION

Bishara J, Mitacek R. Images: Rhythmic movement disorder in a normal developing child with obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2137-2139.