Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder

Objective: To document unusual, nonviolent behaviors during REM sleep behavior disorder (RBD) and evaluate their frequency in Parkinson disease (PD). Background: Most behaviors previously described during RBD mimic attacks, suggesting they proceed from archaic defense generators in the brainstem. Feeding, drinking, sexual behaviors, urination, and defecation have not been documented yet in RBD. Methods: We collected 24 cases of nonviolent behaviors during idiopathic and symptomatic RBD (narcolepsy, dementia with Lewy bodies, PD), reported or observed in videopolysomnography. The frequency of violent and nonviolent behaviors during RBD was evaluated by face to face interview of patients and their cosleepers in a prospective series of 100 patients with PD. Results: Incidental cases of nonviolent behaviors during RBD included masturbating-like behavior and coitus-like pelvic thrusting, mimicking eating and drinking, urinating and defecating, displaying pleasant behaviors (laughing, singing, dancing, whistling, smoking a fictive cigarette, clapping and gesturing thumbs up), greeting, flying, building a stair, dealing textiles, inspecting the army, searching a treasure, and giving lessons. Speeches were mumbled or contained logical sentences with normal prosody. In PD with RBD (n = 60), 18% of patients displayed nonviolent behaviors. In this series (but not in incidental cases), all RBD patients with nonviolent behaviors also showed violent behaviors. Conclusions: Although they are less frequent than violent behaviors, nonviolent behaviors during REM sleep behavior disorder (RBD) fill a large spectrum including learned speeches and culture-specific behaviors, suggesting they proceed from the cortex activation. Sexual behaviors during RBD may expose patients and cosleepers to forensic consequences. Neurology (R) 2009; 72: 551-557