1. A 76 year old man with automatic behavior during sleep
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2015 American Academy of Neurology

2. Vignette Abnormal behavior during sleep with falls and injuries
Excessive daytime sleepiness, more prominent the last 10 years
Restless sleep, frequent arousals and awakenings
Sleep episodes while standing followed by rhythmic marching and jumping and frequent falls
Bonakis et al.
© 2015 American Academy of Neurology

3. Imaging
Figure: Hypnogram of the Video-polysomnography. Severe sleep fragmentation due to periodic limp movement (purple dots-lines) in context of RLS. W:wake, R:REM sleep, N1:sleep stage 1, N2:sleep stage 2, N3: slow wave sleep, PLM: periodic leg movements.
Bonakis et al.
© 2015 American Academy of Neurology

4. Daytime sleepiness and automatic behavior due to severe restless leg syndrome
A reevaluation of patient’s history revealed symptoms compatible with RLS.
Rotidigotine1 proved very effective supporting the diagnosis of RLS.
PLM disorder leading to sleep related rhythmic movement disorder could also be considered.
Automatic behavior denotes severe sleep deprivation2 and may represent a non-REM parasomnia.
Severe RLS may present with automatic behavior complicating its diagnosis.
Reference
1. Birgit Högl, Wolfgang H Oertel, Karin Stiasny-Kolster, Peter Geisler, Heike Beneš, Diego García-Borreguero, Claudia Trenkwalder, Werner Poewe, Erwin Schollmayer, Ralf Kohnen. Treatment of moderate to severe restless legs syndrome: 2-year safety and efficacy of rotigotine transdermal patch. BMC Neurol. 2010; 10: 86.
2. Guilleminault C, Billiard M, Montplaisir J, Dement WC. Altered states of consciousness in disorders of daytime sleepiness. J Neurol Sci. 1975; 26:
Bonakis et al.
© 2015 American Academy of Neurology