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Limb amputation is followed, in approximately 90% of patients, by “phantom limb” sensations during wakefulness. When amputated patients dream, however, the phantom limb may be present all the time, part of the time, intermittently or not at all.1 The absence of the phantom limb when dreaming has been taken as evidence for a pre-existing kinesthetic body scheme, unaffected by the amputation, that is accessible to the patient when asleep.2 Such dreaming experiences in amputees have usually been obtained only retrospectively in the morning and, moreover, dreaming is normally associated with muscular atonia so the motor counterpart of the phantom limb experience cannot be observed directly. REM sleep behaviour disorder (RBD), in which muscle atonia is absent during REM sleep and patients act out their dreams,3 allows a more direct analysis of the “phantom limb” phenomena and their modifications during sleep.
A 58-year-old man had a history of erectile failure and abnormal ejaculation, a 5 year history of orthostatic hypotension and frequent somniloquy with excessive motor activity during sleep, usually accompanied by vivid striking dreams, sometimes of violent content but not causing self- or bed-partner injury. At the age of 39 years, his left arm was amputated at the level of the middle-third of the …