Three Patients With Cancer Who Developed Rapid-Eye-Movement Sleep Behavior Disorder

• Published in: Journal of pain and symptom management Vol. 40; no. 3; pp. 449 - 452
• Main Authors: Shinno, Hideto, MD, PhD, Kamei, Masahito, MD, Maegawa, Tadahiro, MD, Satake, Akira, MD, Inami, Yasushi, MD, PhD, Horiguchi, Jun, MD, PhD, Nakamura, Yu, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2010; Elsevier
• Subjects: Aged; Anesthesia & Perioperative Care; Antipsychotic Agents - therapeutic use; Behaviour disorders; Biological and medical sciences; Cancer; Clonazepam - therapeutic use; Delirium; Delirium - psychology; Diagnosis, Differential; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Female; GABA Modulators - therapeutic use; Humans; Kidney Neoplasms - complications; Male; Medical sciences; Neoplasms - complications; Nervous system (semeiology, syndromes); Neurology; opioids; Organic brain syndrome; Pain - drug therapy; Pain - etiology; Pain Medicine; parasomnia; Pharmacology. Drug treatments; Polysomnography; Rapid eye movement sleep; REM sleep; REM Sleep Behavior Disorder - drug therapy; REM Sleep Behavior Disorder - etiology; REM Sleep Behavior Disorder - psychology; Stomach Neoplasms - complications; Terminally ill people; cancer; parasomnia; polysomnography; REM sleep; opioids; Human; Nervous system diseases; Parasomnia; Sleep disorder; Opiates; Malignant tumor; Polysomnography; Rapid eye movement sleep; Opioid peptide; Case study; Electrodiagnosis; Sleep wake cycle; Behavior; Neurological disorder; Cancer
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2010.01.016

Abstract This article discusses the clinical significance of differentiating parasomnia, such as rapid-eye-movement (REM) sleep behavior disorder (RBD), from delirium in patients with advanced cancer. We describe three patients with advanced cancer who presented with aberrant behavior at night. All three patients developed violent behaviors when they were administered opioids and/or chemotherapy. Polysomnography (PSG) showed REM sleep with tonic electromyography. Previous treatment with neuroleptics had failed to improve their problematic behaviors. Diagnosis was made using criteria for REM behavior disorder of the International Classification of Sleep Disorders , 2nd edition, and PSG. Clonazepam (0.5 mg/day) was administered orally once at night. After treatment with clonazepam, aberrant and violent behaviors were improved. It should be noted that it is not rare for patients with advanced cancer to present with parasomnia, such as RBD, although organic brain syndrome, such as delirium, is more prevalent. Therefore, it is necessary to provide adequate assessment and treatment of aberrant behaviors in cancer patients.