Rhythmic movement disorder

Clinic

• RMD is a neurological disorder characterized by repetitive movements of large muscle groups immediately before and during sleep
• Often involving the head and neck.
• More during NREM sleep, although maybe in REM .
• RMD is often associated with other psychiatric conditions or mental disabilities.
• RMD often leads to bodily injury from unwanted movements
• Many affected individuals also have other sleep related disorders, like sleep apnea.

Differential Diagnosis

• RMD can be differential diagnosed into small subcategories, including
  • Sleep related bruxism
  • Thumb sucking
  • Hypnagogic foot tremor
  • Rhythmic sucking

RMD vs RLS

• RMD involves involuntary muscle contractions before and during sleep
• RLS is the urge to move before sleep.
• RMD occurs in both males and females, often during early childhood with symptoms diminishing with age.

Signs and symptoms

• Most RMD symptoms are relatively passive and do not cause any pain.
• Many patients are often unaware that an episode is occurring or has occurred.
• The rhythmic movements may produce some bodily injury via falls or muscle strains, but this is not reported in all patients

Miasmatic analysis

• Seizure: Both have Involuntary, Rhythmic movement
• The most similar epilepsy would be local / Frontal lobe epilepsy. Since in this type of epilepsy, we have complex pattern of movement (Automatism / stereotypies)
• Consciousness altered:

Motor symptoms

Symptoms of rhythmic movement disorder vary, but most share common large muscle movement patterns. Many show consistent symptoms including:

• body rocking, where the whole body is moved while on the hands and knees.
• head banging, where the head is forcibly moved in a back and forth direction.
• head rolling, where the head is moved laterally while in a supine position.

Other less common muscle movements include:

• body rolling, where the whole body is moved laterally while in a supine position.
• leg rolling, where one or both legs are moved laterally.
• leg banging, where one or both legs are moved in a back and forth direction.
• a combination of the aforementioned symptoms

The majority of affected individuals have symptoms that involve the head, and the most common symptom is head banging. Usually, the head strikes a pillow or mattress near the frontal-parietal region. There is little cause for alarm at the movements as injury or brain damage as a result of the movements is rare. Some infants with diagnosed Costello Syndrome have been observed to have unique RMD episodes affecting the tongue and other facial muscles, which is an uncommonly affected area. Episodes usually last less than fifteen minutes and produce movements that vary from 0.5 to 2 Hz.

Muscle movements during REM sleep are often twitches and occur simultaneously with normal sleep. The position of the body during sleep may determine which motor symptom is displayed. For example, Anderson et al. reported that one individual showed entire body rolling movements while sleeping on his side while displaying head rolling movements when sleeping supine.

Brain activity

• RMD is observed using the standard procedure for polysomnography. These aforementioned brain monitoring devices eliminate the possibility of epilepsy as a cause.

Related disease

• The disorder is closely associated with developmental disabilities or autism.
• More recent studies have shown there is a strong link between prolonged RMD and ADHD.
• Sleep apnea

Causes

• The direct pathophysiological basis of RMD is still unknown
• Rare cases of adult RMD have developed due to head trauma, stress, and herpes encephalitis.
• An alternative theory suggests that the rhythmic movements help develop the vestibular system in young children