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We report a 34-year-old woman with Möbius syndrome in association with lifelong sleep disturbance diagnosed as rapid eye movement (REM) sleep behaviour disorder (RBD). RBD proved treatment resistant and the possible structural reasons for this are discussed.
The patient was a 34-year-old woman who was noted at birth to have bilateral abducens nerve palsy, complete facial diplegia, club feet, malformation of the right upper limb and chest wall with an underdeveloped right hand and an absent pectoralis major. These abnormalities were non-progressive and a diagnosis of Möbius syndrome was made based on the characteristic clinical features. The Poland anomaly (pectoralis major hypoplasia and mammary hypoplasia) is associated with 13% of cases of Möbius syndrome.1
From birth, the patient’s mother noted sleep disturbance with brief crying and vocalisation as well as twitching arm and leg movements during sleep. The sleep disturbance became more marked over time and by the age of 3 years until the current day she has suffered episodes of screaming and abnormal movements occurring in the second half of the night on a nightly basis, usually between 02:00 and 04:00. Her mother described screaming with non-stereotyped, flailing movements of her arms and legs lasting several minutes. The patient’s legs often moved as if running in the bed. She had injured both herself and her mother when …