Aims Rhythmic Movement Disorder (RMD) is characterised by rhythmic, repetitive, stereotyped motor behaviours at a frequency of 0.5–2 seconds associated with sleep. Typical onset is in infancy with a male preponderance of 4:1. Episodes such as head banging occur at sleep onset or during periods of sleep-wake transitions. Successful treatment is often difficult with scant evidence for the four typically recommended modalities:
Aversion Therapy – non-punitive arousal
Sleep restriction and hypnotics- Delaying sleep along with hypnotic use
Clonazepam – low dose at bedtime
Stimulus Substitution – rhythmic sounds or vestibular stimulations e.g. metronome/hammock.
Methods Retrospective case review of 15 patients with RMD, attending a tertiary Sleep clinic from 2005–2013.
Most common presentation – head banging (n = 9), body rolling (n = 6); or both (n = 5).
Strong male preponderance (13:2); median age of presentation 7yrs (range 2yrs–13.5yrs).
Majority (3) had symptom onset in infancy.
Majority, (n = 13) had RMD at sleep onset and then repeatedly during sleep-wake transitions. Two, did not have RMD at sleep onset.
Comorbidities: Four had behavioural difficulties like ADHD and three had mild to severe learning disability.
Aversion therapy was considered appropriate for 6 patients of whom 3 showed complete or significant (>50%) resolution of symptoms.
Clonazepam (for 6–16 weeks only) was considered appropriate in 8 – only one showed significant resolution of symptoms. Sleep onset RMD persisted in 3, although symptoms during sleep resolved.
Stimulus substitution used in 3 with minor beneficial effect.
Hammock use led to complete resolution of symptoms in one child.
Sleep hygiene advice and RMD education was the only intervention in 3 patients with significant improvement of RMD.
In all children motivation to improve affected outcome.
Conclusion RMD is a conditioned behaviour and treatment is likely to have the maximum chance of success if the child is motivated to change and an appropriate behavioural strategy is used. Randomised treatment trials are urgently needed for this distressing condition.