Reactions 1680, p335 - 2 Dec 2017 REM sleep behavioural disorder leading to fractures: case report A 55-year-old woman developed REM sleep behavioural disorder [RBD], leading to radius and metatarsal fractures during venlafaxine therapy. The woman, presented to the sleep medicine clinic with insomnia and sleepwalking complaints. She reported sleep onset and maintenance insomnia and used to wake up feeling unrefreshed and tired the following day. She also reported sleepwalking and sleepeating, usually occurring around 2:30 in the morning. Because of her nighttime behaviours, she sustained two fractures. About a year ago, she fractured the base of her left fifth metatarsal and was treated with a fracture boot. Additionally, she sustained a comminuted, dorsally- displaced right distal radius fracture, which required open reduction and internal fixation with a plate and screws. She mentioned that she had been experiencing these symptoms for past 13 years. Further questioning and medication review revealed that, she had started venlafaxine 150mg extended release 13 years ago [indication, route and frequency not stated]. A diagnosis of venlafaxine-induced REM sleep behavioral disorder was made. The polysomnography had no focal findings of an RBD episode. The woman’s venlafaxine dose was cross-titrated with buproprion. The dose was reduced to 37.5mg for a week and then discontinued. She was started on bupropion and her methylphenidate was tapered and stopped as well. Subsequently, the frequency of her symptoms reduced, and after stopping venlafaxine complete resolution of her symptoms was achieved. Author comment: "Our patient suffered from venlafaxine- induced RBD for around 13 years." "She even suffered through two fractures and had to undergo surgery because of it." Ryan Williams R, et al. Venlafaxine-induced REM sleep behavioral disorder presenting as two fractures. Trauma Case Reports 11: 18-19, Oct 2017. Available from: URL: http://doi.org/10.1016/j.tcr.2017.10.017 - USA 803284603 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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