• Korean Journal of Radiology
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• 제24권3호
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• pp.247-258
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• 2023

Objective: To localize the neuroanatomical substrate of rapid eye movement sleep behavior disorder (RBD) and to investigate the neuroanatomical locational relationship between RBD and α-synucleinopathy neurodegenerative diseases. Materials and Methods: Using a systematic PubMed search, we identified 19 patients with lesions in different brain regions that caused RBD. First, lesion network mapping was applied to confirm whether the lesion locations causing RBD corresponded to a common brain network. Second, the literature-based RBD lesion network map was validated using neuroimaging findings and locations of brain pathologies at post-mortem in patients with idiopathic RBD (iRBD) who were identified by independent systematic literature search using PubMed. Finally, we assessed the locational relationship between the sites of pathological alterations at the preclinical stage in α-synucleinopathy neurodegenerative diseases and the brain network for RBD. Results: The lesion network mapping showed lesions causing RBD to be localized to a common brain network defined by connectivity to the pons (including the locus coeruleus, dorsal raphe nucleus, central superior nucleus, and ventrolateral periaqueductal gray), regardless of the lesion location. The positive regions in the pons were replicated by the neuroimaging findings in an independent group of patients with iRBD and it coincided with the reported pathological alterations at post-mortem in patients with iRBD. Furthermore, all brain pathological sites at preclinical stages (Braak stages 1-2) in Parkinson's disease (PD) and at brainstem Lewy body disease in dementia with Lewy bodies (DLB) were involved in the brain network identified for RBD. Conclusion: The brain network defined by connectivity to positive pons regions might be the regulatory network loop inducing RBD in humans. In addition, our results suggested that the underlying cause of high phenoconversion rate from iRBD to neurodegenerative α-synucleinopathy might be pathological changes in the preclinical stage of α-synucleinopathy located at the regulatory network loop of RBD.

• 대한한방내과학회지
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• 제43권3호
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• pp.436-443
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• 2022

Objectives: This study examined the case of a 69-year-old man with a history of stroke and Alzheimer's disease who had been diagnosed with probable-rapid eye movement sleep behavior disorder (probable-RBD). Methods: The patient was treated with herbal medicine (Ukgan-san, Ukgansangayonggolmoryeo-tang, and powdered Gamisoyo-san extract), Western medicine (clonazepam, antiplatelet, psychotropic agents, antihypertensive drugs, and others), and acupuncture. Their effects were evaluated by the frequency and severity of sleep-related behavioral symptoms. Results: After treatment, the observed frequency and severity of sleep-related behavior decreased. Conclusion: The results suggest that using traditional Korean medicine with clonazepam can be effective in the treatment of patients with probable-RBD.