Background: Sleep-related rhythmic movement disorder occurs frequently in childhood with a minority of patients having persistent symptoms in adolescence.



Phenomenology Shown: We describe a 14-year-old female showing a typical example of head banging at onset of sleep.



Educational Value: Sleep-related rhythmic movement disorder usually has a benign and self-limiting nature and medication might only be warranted in cases of severe sleep disruption or frequent injuries

Femke Dijkstra

Harald de Cauwer

Inge Beijer

Mineke Viaene

Tremor and Other Hyperkinetic Movements

Background: Sleep-related rhythmic movement disorder occurs frequently in childhood with a minority of patients having persistent symptoms in adolescence.

Phenomenology Shown: We describe a 14-year-old female showing a typical example of head banging at onset of sleep.

Educational Value: Sleep-related rhythmic movement disorder usually has a benign and self-limiting nature and medication might only be warranted in cases of severe sleep disruption or frequent injuries

Dijkstra, Femke

Viaene, Mineke

Beijer, Inge

de Cauwer, Harald

Columbia University Academic Commons

Video AbstractsRockin’ Yourself AsleepFemke Dijkstra1,2*, Mineke Viaene1,3, Inge Beijer1,3& Harald de Cauwer2,31 Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium, 2 Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,3Department of Neurology, St. Dimpna Regional Hospital, Geel, BelgiumAbstractBackground: Sleep-related rhythmic movement disorder occurs frequently in childhood with a minority of patients having persistent symptoms in adolescence.Phenomenology Shown: We describe a 14-year-old female showing a typical example of head banging at onset of sleep.Educational Value: Sleep-related rhythmic movement disorder usually has a benign and self-limiting nature and medication might only be warranted in cases ofsevere sleep disruption or frequent injuries.Keywords: Sleep disorders, sleep-related rhythmic movement disorder, headbanging, polysomnographyCitation: Dijkstra F, Viaene M, Beijer I, de Cauwer H. Rockin’ yourself asleep. Tremor Other Hyperkinet Mov. 2018; 8. doi: 10.7916/D8S4888G* To whom correspondence should be addressed. E-mail: femke.dykstra@zna.beEditor: Elan D. Louis, Yale University, USAReceived: April 5, 2018 Accepted: May 7, 2018 Published: June 4, 2018Copyright: ’ 2018 Dijkstra et al. This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommercial–No Derivatives License, whichpermits the user to copy, distribute, and transmit the work provided that the original authors and source are credited; that no commercial use is made of the work; and that the work is notaltered or transformed.Funding: None.Financial Disclosures: None.Conflict of Interest: The authors report no conflict of interest.Ethics Statement: This study was performed in accordance with the ethical standards detailed in the Declaration of Helsinki. All patients that appear on video have provided writteninformed consent; authorization for the videotaping and for publication of the videotape was provided.We present a healthy 14-year-old normally developed female withno known medical or psychiatric history, suffering from abnormalhead movements during her sleep. The symptoms started 10 years agoand have been occurring several times a week since then. As a con-sequence, she has suffered from excessive daytime sleepiness (EpworthSleeping Scale score, 16; normal ,10).The results of the clinical neurological examination were normal.She underwent a polysomnography (Video 1, Figure 1) that showedthree episodes (1–8 minutes) of rhythmic head flexion and extension,suggestive of ‘‘head banging’’, during onset of sleep and non-Rapid EyeMovement sleep (Stages 1 and 2). Furthermore, the polysomnographyshowed an increased arousal index (13 per hour, normal ,10 perhour) without any pathological epileptic, respiratory, or periodic limbmovement events.On the basis of a typical history and semiology, the patient wasdiagnosed with sleep-related rhythmic movement disorder (SRMD).She was informed about SRMD and different treatment options, butpreferred no treatment.SRMD is defined as a group of stereotypic, repetitive, and rhythmicmovements of large muscle groups within 0.5–2 Hz, resulting in headbanging (Video 1), body rocking, or head rolling.1 SRMD typicallystarts at young age and the movements usually appear while fallingasleep. They can, however, occur during all stages of sleep and maylast from several minutes to even a few hours. A detailed parent reportand polysomnography can help to differentiate SRMD from othersleep-related movement disorders, nocturnal epilepsy, parasomnias,and motor stereotypies in neurodevelopmental disabilities.Video 1. Video-polysomnography. Examination shows a classical exampleof head banging. Our patient is in prone position and shows rhythmic headflexion and extension, starting after non-Rapid Eye Movement sleep.Freely available onlineTremor and Other Hyperkinetic Movementshttp://www.tremorjournal.org Columbia University Libraries1Sleep-related rhythmic movements occur frequently in infants andare only regarded as a disorder when causing injuries or interferingwith sleep quality,1 which may result in increased daytime sleepiness.2The association with developmental disorders, psychological distress,and other sleep disorders has been described, but this has not beenshown universally.3 Most children with SRMD show no comorbidities.SRMD normally stops during childhood (,5 years) with only a minorityof patients suffering from persistent symptoms into adolescence.3Currently, there are no evidence-based therapy guidelines. Behav-ioral approaches have shown inconsistent results.3 Several case studieshave reported an effect of benzodiazepines and two cases weresuccessfully treated with haloperidol and imipramine.3 Medication,however, might only be warranted in cases of severe sleep disruption orfrequent injuries. It is important to explain the disorder’s benign andself-limiting nature and to create a safe environment, preventing thepatient from harming him/herself.3References1. American Academy of Sleep Medicine. International classification of sleepdisorders: diagnostic and coding manual. 2nd edn. Westchester, IL; 2005.2. Neve´us T, Cnattingius S, Olsson U, Hetta J. Sleep habits and sleepproblems among a community sample of schoolchildren. Acta Paediatr 2001;90:1450–1455. doi: 10.1111/j.1651-2227.2001.tb01612.x3. Gwyther ARM, Walters AS, Hill CM. Rhythmic movement disorder inchildhood: an integrative review. Sleep Med Rev 2017;35:62–75. doi: 10.1016/j.smrv.2016.08.003Figure 1. Polysomnographic findings during Video 1. This 1-minute polysomnographic epoch (150 mV) with electroencephalography (EEG) and mentalismuscle electromyography (EMG) recordings shows non-Rapid Eye Movement sleep interrupted by an arousal (black arrow), after which the patient startsheadbanging (green arrow). The rhythmic movement artifacts on the EEG and EMG channels are typical for sleep-related rhythmic movement disorder.Dijkstra F, Viaene M, Beijer I, et al. Rockin’ Yourself AsleepTremor and Other Hyperkinetic Movementshttp://www.tremorjournal.org Columbia University Libraries2

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Rockin’ Yourself Asleep

Abstract: Background: Sleep-related rhythmic movement disorder occurs frequently in childhood with a minority of patients having persistent symptoms in adolescence. Phenomenology Shown: We describe a 14-year-old female showing a typical example of head banging at onset of sleep. Educational Value: Sleep-related rhythmic movement disorder usually has a benign and self-limiting nature and medication might only be warranted in cases of severe sleep disruption or frequent injuries

Rockin’ Yourself Asleep

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