Most<unk>  symptoms are relatively passive and do not cause any pain. Many patients are often unaware that an episode is occurring or has occurred. The<unk><unk> s may produce some bodily injury via falls or muscle strains, but this is not reported in all patients . In unique cases,<unk>  sufferers hum or moan while asleep during an episode. Some patients describe the repetitive<unk> s as relaxing and are only occasionally awakened by an<unk>  episode. Often, it is the sufferer’s partner or parent who first notes the symptoms. Additionally, it is often the partner or parent who led patients to seek medical attention. Motor symptoms Symptoms of<unk>  vary, but most sufferers share common large muscle<unk>  patterns. Many sufferers 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<unk> s 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 sufferers 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<unk> s as injury or brain damage as a result of the<unk> s is rare. Some infants with diagnosed Costello Syndrome have been observed to have unique<unk>  episodes affecting the tongue and other facial muscles, which is an uncommonly affected area. Episodes usually last less than fifteen minutes and produce<unk> s that vary from 0.5 to 2 Hz. Muscle<unk> s 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<unk> s while sleeping on his side while displaying head rolling<unk> s when sleeping supine. Sleep Because of the abnormal writhing<unk> s, often patients’ sleep patterns are disrupted. This may be due to<unk> ’s comorbidity with sleep apnea, which has been observed in some patients . Many find that their sleep is not refreshing and are tired or stressed the following day, despite getting a full nights rest. However, other patients report that their sleep patterns are infrequently interrupted due to<unk>  episodes and do not report being excessively sleepy during the next day as scored on the Epworth Sleepiness Scale. Thus, as can be seen, the effects and severity of<unk>  vary from person to person. Brain activity<unk>  is observed using the standard procedure for polysomnography, which includes video recording, EEG during sleep, EMG, and ECG. These aforementioned brain monitoring devices eliminate the possibility of epilepsy as a cause. Other sleep related<unk> s like sleep apnea are ruled out by examining the patients’ respiratory effort, air flow, and oxygen saturation.<unk>  patients often show no abnormal activity that is directly the result of the<unk>  in an MRI scan.<unk>  episodes are strongly associated with stage 2 NREM sleep and, specifically, K Complexes . Additionally, there is a close association with Alpha waves that contain a mixture of K complexes and arousals, regardless of the NREM stage in which the<unk>  occurred. The occurrence of these two sequences of brain waves suggests that the<unk>  is linked to an “unstable vigilance level” throughout NREM sleep . It has been noted that there is a complete absence of any EEG signs during or immediately after an intense<unk><unk>  . After the episode, normal EEG patterns return. Functional MRI scans have shown that the mesencephalon and pons may be involved in the loss of motor control seen during an<unk>  episode, which is similar to other<unk><unk> s Episodes Episodes of<unk>  are short, lasting between 3 and 130 seconds. Rare cases of constant<unk>  can last for hours. The majority of<unk>  episodes usually occur just before or during sleep. Some cases have been reported on<unk><unk> s during wakeful activities like driving. When occurring in sleep,<unk>  episodes are more likely to onset during non-REM, stage 2 sleep. Roughly 46% of sleep-RMD episodes occur only in non-REM sleep; 30% in non-REM and REM; and only 24% strictly in REM sleep. Most patients are unresponsive during an episode and are unlikely to remember the<unk> s occurring upon awakening. In some patients who also experience sleep apnea, episodes of apnea can be followed immediately by<unk> -like symptoms, suggesting that the apnea episodes may trigger an<unk>  episode. Similarly, current studies suggest that external stimuli are not the cause of<unk>  episodes. Associated conditions The<unk>  is closely associated with developmental disabilities or autism. More recent studies have shown there is a strong link between prolonged<unk>  and ADHD.
Rhythmic movement disorder
Essential tremor
Dopamine-responsive dystonia
Benign fasciculation syndrome
Torsion dystonia
Paroxysmal exercise-induced dystonia
Focal dystonia
Stiff-person syndrome