At months of age no obvious physical

At 51 months of age, no obvious physical abnormalities were found. Kampo (yokukansan) showed no effect but clonazepam (0.1–0.2mg) showed favorable effects on the intensity and frequency of arm banging. We have attempted to increase the dose of clonazepam gradually, but no complete remission has been obtained at the age of 57 months of age.
Discussion RMD is also described as jactatio capitis nocturna, jactatio corporis nocturna and rhythmie du sommeil [1]. The clinical manifestation of our patient is compatible with RMD, except for the movement involved. Involuntary jerking movements of the arms and torso have been recently reported in a neurologically unaffected 10-year-old girl while recovering from general anesthesia [3]. Su et al. reported [4] a 15-year-old boy who cetrimonium bromide presented with multiple complex rhythmic movements during sleep, including bilateral rhythmic arm rocking and rhythmic hand movements. To the best of our knowledge, our patient is the youngest case of RMD showing arm banging. Several RMD patients showed symptoms before 3 months of age [5]. The current patient showed his first symptoms at 7 months of age. Interestingly, repetitive arm and hand banging during wakefulness is reported in infants aged 9 months of age or older [6]. Neuronal pathways involved in arm banging may be active during infancy. According to the ICSD3 [1], injury to soft tissues or bone has been reported in patients with RMD. Fortunately, our patient has not suffered from such complications. However, his parents were afraid of him hitting his eyes. Their concern kept them awake during the night to protect their son׳s eyes from arm banging. Although we failed to propose an idea to address the concerns of the parents of this patient to restore their sleep, staff involved in child sleep should investigate ways to solve their concern. Clonazepam showed mild effects on this patient, although its universal effectiveness on RMD has not been approved [2]. A familial pattern has been reported rarely in this clinical concept, as has occurrence in identical twins [1]. The association of sleep related eating episodes of his mother and the boy׳s sleep related arm banging remains to be elucidated.