REM Sleep Behavior Disorder

Posted on April 10, 2026 by Patrick Hercules

Rapid eye movement (REM) sleep behavior disorder occurs when a person unknowingly, physically acts out their vivid, often bad dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep.

People don’t normally move during REM sleep, which is a normal stage of sleep that occurs many times during the night.

About 20% of a person’s sleep is REM sleep, the usual time when dreaming occurs, primarily during the second half of the night.

REM sleep behavior disorder may be linked to neurological conditions, such as:

Lewy body dementia
Parkinson’s disease
Multiple system atrophy

The onset of REM sleep behavior disorder can be gradual or sudden, and it can worsen over time. Episodes of the disorder occur occasionally or several times a night.

Symptoms of REM sleep behavior disorder include:

Movements, such as kicking, punching, arm flailing, or jumping from bed, in response to action-filled or violent dreams, such as being chased or fighting off an attack
Noises, such as talking, laughing, shouting, emotional outcries, or even cursing
Being able to recall the dream if awoken during the episode

Usually, the nerve pathways in the brain that prevent muscles from moving are active during normal REM sleep, which results in temporary paralysis of the body. However, in REM sleep behavior disorder, the nerve pathways no longer work, causing a person to physically act out their dreams.

There are several risk factors associated with the development of REM sleep behavior disorder, including:

Having a certain type of neurodegenerative disorder
Taking certain medications
Having narcolepsy
Being male and over 50 years old

Additionally, recent evidence indicates there may also be several specific environmental or personal risk factors for REM sleep behavior disorder, including:

Occupational pesticide exposure
Farming
Smoking
A previous head injury

REM sleep behavior disorder can cause various complications, including:

Injury to yourself or your sleeping partner
Distress to your sleeping partner or other people living in your home
Social isolation for fear that others may become aware of your sleep disruption

To diagnose REM sleep behavior disorder, a healthcare provider reviews your medical history and symptoms. The evaluation can include:

Physical and neurological exam
Nocturnal sleep study
Talking with your sleeping partner

A healthcare provider uses the symptom criteria in the International Classification of Sleep Disorders, Third Edition (ICSD-3). The criteria include:

You have repeated times of arousal during sleep where you talk, make noises, or perform complex motor behaviors, such as punching, kicking, or running movements, that often relate to the content of your dreams
You recall dreams associated with these movements or sounds
If you awaken during an episode, you are alert and not confused or disoriented
A sleep study shows you have an increase in muscle activity during REM sleep
Your sleep disturbance is not caused by another disturbance, a mental health disorder, medication, or substance abuse

REM sleep behavior disorder can be the first indication of the development of a neurodegenerative disease, such as Parkinson’s disease, multiple system atrophy, or dementia with Lewy bodies.

Treatment for REM sleep behavior disorder may include physical safeguards and medications.

Physical safeguards make it safer for you and your bed partner.

Medications such as melatonin and clonazepam can be prescribed to help treat REM sleep behavior disorder.

If you are experiencing any symptoms of REM sleep behavior disorder, you can consult with a neurologist at Jamaica Hospital Medical Center. To schedule an appointment, please call (718) 206-7246.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

World Epilepsy Awareness Day (Purple Day)

Posted on March 26, 2026 by Patrick Hercules

World Epilepsy Awareness Day, or Purple Day, is observed on March 26th, a global initiative to raise awareness of epilepsy and support the millions of people living with it worldwide.

Approximately 65 million people are living with epilepsy across the world, and one in 26 people in the U.S. will be diagnosed with epilepsy during their lifetime.

Epilepsy is a brain condition that causes recurring seizures. Most people who suffer from epilepsy generally have the same type of seizure each time, and symptoms are usually similar from episode to episode. The symptoms of seizures can vary depending on the type of seizure, and because epilepsy is caused by certain activity in the brain, seizures can affect any brain process. Seizure symptoms may include:

Short-term confusion.

A staring spell.

Stiff muscles.

Jerking movements of the arms and legs.

Loss of consciousness.

Psychological symptoms such as fear, anxiety, or déjà vu.

Sometimes people with epilepsy may have changes in their behavior and may also experience psychosis.

Seizures can be categorized as either focal or generalized, based on where in the brain the brain activity that causes the seizure originates.

Focal seizures are the result of brain activity in just one area of the brain. Focal seizures can fall into two categories: focal seizures with preserved consciousness or focal seizures with impaired consciousness.

Types of focal seizures include:

Temporal lobe seizures

Frontal lobe seizures

Occipital lobe seizures

Focal seizures may have warning signs called auras in the moments before a seizure begins. Auras might include a feeling in the stomach, emotions such as fear, or the feeling of déjà vu. They can also be a taste, a smell, or a visual, such as a steady or flashing light, a color, or a shape. Some people may even experience dizziness and loss of balance, or hallucinations.

Generalized seizures are seizures that involve all areas of the brain. Types of generalized seizures include:

Absence seizures

Tonic seizures

Atonic seizures

Clonic seizures

Myoclonic seizures

Tonic-clonic seizures

There is no identifiable cause of epilepsy in about half of the people with the condition. In the other half, the condition may be traced to various factors, including:

Family history of epilepsy

Head trauma

Brain tumors

Infections, such as meningitis, HIV, viral encephalitis, and some parasitic infections

Abnormal blood vessel formation or bleeding in the brain

Alzheimer’s disease

Strokes, heart attacks, and other conditions that deprive the brain of oxygen

Brain inflammation or swelling

Alcoholism or alcohol withdrawal

Injury before birth

Developmental conditions

Seizures can be caused by environmental triggers. These seizure triggers don’t cause epilepsy, but they may trigger seizures in people who suffer from epilepsy. Most people with epilepsy don’t have reliable triggers that always cause seizures. However, there are often factors that make it easier to have a seizure, including:

Flashing lights

Alcohol

Illicit drug use

Lack of sleep

Stress

Dehydration

Skipping doses of anti-seizure medicines or taking more than prescribed

Skipped meals

Illness

Epilepsy is diagnosed when a healthcare provider reviews your symptoms and medical history. They may perform several tests to diagnose epilepsy and to detect the cause of seizures. These tests include:

A neurological exam

Blood tests

Genetic testing

A healthcare provider may also request brain-imaging tests and scans that detect brain changes, including:

Electroencephalogram (EEG)

High-density EEG

CT scan

Functional MRI (fMRI)

PET scan

Single-photon emission computerized tomography (SPECT)

Neuropsychological tests

Along with the test results of these brain-imaging tests, a combination of other techniques may be used to help pinpoint where the seizures start in the brain. They include:

Statistical parametric mapping (SPM)

Electrical source imaging (ESI)

Magnetoencephalography (MEG)

Treatment can help people who have been diagnosed with epilepsy have fewer seizures or even completely stop having seizures. These treatments include:

Medicines

Therapies that include devices that stimulate the brain

Surgery

A ketogenic diet

If you are experiencing any symptoms of epilepsy, you can consult with a neurologist at Jamaica Hospital Medical Center. To schedule an appointment, please call (718) 206-7246.

Treatments to Reduce Alzheimer’s Disease

Posted on March 18, 2026 by Patrick Hercules

Alzheimer’s disease is a degenerative brain disease and the most common type of dementia. It causes a slow decline in memory, thinking, and reasoning skills. Age is the biggest risk factor for the disease, followed by sex and family history.

There is currently no cure for Alzheimer’s disease. However, there is progress in Alzheimer’s and dementia research that is creating promising new treatments for those living with the disease.

The U.S. Food and Drug Administration (FDA) has approved medications for Alzheimer’s disease, which fall into two categories:

· Drugs that change disease progression in people living with early Alzheimer’s

· Drugs that temporarily ease some symptoms of Alzheimer’s

Drugs that change disease progression target the underlying biology of the disease process by aiming to slow the decline of memory and thinking, as well as function.

Anti-amyloid treatments work by removing a protein that accumulates into plaques in the brain, called beta-amyloid. Each treatment works differently and targets beta-amyloid at a different stage of plaque formation.

These treatments change the course of the disease significantly for those who are in the early stages by giving them more time to be able to participate in daily activities and live independently.

The two treatment therapies that change disease progression are Donanemab and Lecanemab.

Donanemab is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks to treat early Alzheimer’s disease, which includes people who are living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s who have been diagnosed with elevated beta-amyloid in the brain.

Donanemab was the third therapy that demonstrated that removing beta-amyloid from the brain decreases cognitive and functional decline in people living with early Alzheimer’s disease.

Lecanemab was the second therapy to demonstrate that removing beta-amyloid from the brain decreases cognitive and functional decline in people living with early Alzheimer’s disease.

It is important to note that anti-amyloid treatments do have side effects, such as allergic reactions, amyloid-related abnormalities (ARIA), infusion-related reactions, headaches, and falls.

As Alzheimer’s progresses, brain cells die, and the connections among those cells are lost. When this occurs, it causes cognitive and noncognitive symptoms to worsen.

Although these medications don’t stop the damage that Alzheimer’s disease causes to brain cells, they may lessen or stabilize symptoms for a limited time by affecting specific chemicals involved in delivering messages among and between the brain’s nerve cells.

The medications that are prescribed to treat symptoms related to memory and thinking include:

Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment, and other thought processes. These medications prevent the breakdown of a chemical messenger important for memory and learning, called acetylcholine. Cholinesterase inhibitors support communication between nerve cells. The most prescribed cholinesterase inhibitors include:

· Benzgalantamine treats mild-to-moderate dementia due to Alzheimer’s disease

· Donepezil treats mild-to-severe dementia due to Alzheimer’s disease

· Galantamine treats mild-to-moderate dementia due to Alzheimer’s disease

· Rivastigmine treats mild-to-moderate dementia due to Alzheimer’s disease as well as mild-to-moderate dementia due to Parkinson’s disease

Possible side effects for these medications include:

· Headache

· Dizziness

· Diarrhea

· Increased frequency of bowel movements

· Nausea

· Vomiting

· Loss of appetite

Glutamate regulators are medications prescribed to improve memory, attention, reasoning, language, and the ability to perform simple tasks. This medication regulates the activity of glutamate, a different chemical messenger that helps the brain process information.

Memantine is a glutamate regulator that treats moderate-to-severe Alzheimer’s disease. It can cause side effects that include headaches, constipation, confusion, and dizziness.

A cholinesterase inhibitor combined with a glutamate regulator, such as donepezil and memantine, treats moderate-to-severe Alzheimer’s disease. Possible side effects can include nausea, vomiting, loss of appetite, confusion, dizziness, increased frequency of bowel movements, and constipation.

Alzheimer’s disease doesn’t just impact memory and thinking. It also impacts a person’s quality of life by affecting a variety of behavioral and psychological symptoms that come with dementia, such as agitation, hallucinations and delusions, and sleep disturbances. Some medications focus on treating these non-cognitive symptoms for a time; however, it is important to try non-drug strategies to manage behaviors before adding medications.

The FDA has approved only one drug to manage symptoms of insomnia that has been tested in people who are living with dementia, and one that treats agitation.

Orexin receptor antagonists are prescribed to address symptoms of insomnia and inhibit the activity of a type of neurotransmitter involved in the sleep-wake cycle called orexin.

Suvorexant treats insomnia and has been shown in clinical trials to be effective for people who are living with mild to moderate Alzheimer’s disease. Possible side effects can include a risk of impaired alertness and motor function, worsening depression or suicidal thinking, complex sleep behaviors, sleep paralysis, and compromised respiratory function.

Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. These drugs are mainly used to treat schizophrenia and bipolar disorder, as well as add-on therapies for major depressive disorder. The FDA requires that all atypical antipsychotics carry a safety warning that the medication has been associated with an increased risk of death in older patients who are experiencing dementia related psychosis.

Many atypical antipsychotic medications are used “off-label” to treat dementia-related behaviors, and there is only one FDA-approved atypical antipsychotic to treat agitation associated with dementia due to Alzheimer’s disease. It is important to try non-drug strategies to help manage non-cognitive symptoms such as agitation before adding any medications.

Brexpiprazole treats agitation associated with dementia due to Alzheimer’s disease. Possible side effects may include weight gain, sleepiness, common cold symptoms, dizziness, and restlessness.

If you or a loved one is experiencing any symptoms of Alzheimer’s disease or would like to learn more about treatment options, you can consult with a neurologist at Jamaica Hospital Medical Center. To schedule an appointment, please call (718) 206-7246.

Botox for Migraines

Posted on March 14, 2026 by Patrick Hercules

Chronic migraines are a severe, recurring type of headache that is often debilitating. Migraines have four phases, which are prodrome, aura, migraine headache, and postdrome.

Although the exact cause of migraines is unknown, researchers believe genetics is a factor.

There are a few conditions and lifestyle factors that can trigger a migraine, including:

Anxiety

Bipolar disorder

Depression

Epilepsy

Sleep disorders

Caffeine or withdrawal from caffeine

Taking certain medications or taking them too often

Migraines are more likely to occur in the morning, making it common to wake up with a migraine. Some people have a predictable pattern of migraines, such as just before a menstrual period. Other people may have trouble recognizing what triggers their migraines.

There is no cure for migraines, but they can be managed and prevented with over-the-counter triptans and pain relievers.

Another treatment that can be used for chronic migraines is Botox. Botox for migraines is a type of botulinum toxin that may prevent chronic migraines and is only recommended by a healthcare provider if a person has 15 or more headaches per month.

Although Botox is mostly known for its cosmetic use, it has medical benefits, such as blocking pain signals before they reach the brain, as certain nerves are highly active during a migraine.

To prevent this from happening, a healthcare provider injects Botox into specific muscles in the head, neck, and shoulders using a tiny needle. These areas connect to the nerves that send pain signals during a migraine. Botox travels along these connected nerves towards the brainstem and blocks the release of chemicals that trigger pain. This may reduce how often a person gets a migraine or make their symptoms less severe when they experience one.

Before receiving Botox for migraine treatment, you will meet with your healthcare provider, who will explain the risks and benefits of it and make sure that it is a safe option for you. If you agree to move forward, you will sign a consent form.

It is important to let your healthcare provider know about any medications and supplements that you are currently taking, as Botox may interact with different types, such as muscle relaxants.

Botox has many side effects, including:

Mild pain and bruising at the injection site

Neck pain and stiffness

Headache

Flu-like symptoms

Temporary changes in appearance

These side effects are usually minimal and will clear up. Let your healthcare provider know if you are experiencing any severe pain or discomfort.

The main benefits of Botox for migraines are that it reduces:

The severity of migraines

The frequency of migraines

The duration of migraines

Botox for migraines has other benefits, including:

It’s effective with long-term use and has minimal complications

It can be combined with other migraine medications

The side effects may be better tolerated than other medications available

Chronic migraines can be painful and debilitating, and trying to find the right treatment to provide relief can be difficult and frustrating. If you are suffering from chronic migraines and haven’t found the right treatment options to relieve your symptoms, discuss Botox treatment for migraines with your healthcare provider.

If you are experiencing any symptoms of chronic migraines and are interested in Botox for migraines, you can consult with a neurologist at Jamaica Hospital Medical Center. To schedule an appointment, please call (718) 206-7246.

Muscle Spasms

Posted on March 6, 2026 by Patrick Hercules

Muscle spasms or muscle cramps are painful contractions and tightening of the muscles. Muscle spasms occur when the muscles involuntarily and forcibly contract and cannot relax.

Muscle spasms are normal and very common, and can involve part of, or all of, a muscle or several muscles in a group. These spasms can occur anywhere in the body. The most common types of muscle spasms include:

Back spasms

Leg cramps and charley horses

Neck spasms

Arm spasms

Abdomen spasms

Ribcage spasms

Chest spasms

Muscle spasms can occur in anyone at any time, including while walking, sitting, exercising, or sleeping. Some individuals are more susceptible to muscle spasms than others and experience them regularly with any type of exertion. People most likely to get muscle spasms include:

Athletes

Pregnant women

Infants

People who are obese

People over the age of 65

Most of the time, muscle spasms aren’t something to worry about. However, muscle cramps can indicate an underlying neurological condition that affects the brain. Involuntary muscle movements resulting from a neurological condition are called dystonia.

Muscle spasms range from mild to severe. Mild muscle spasms feel like the muscle is jumping around on its own and can be seen twitching. Severe muscle spasms feel like the entire muscle stiffens into a tight ball. If the cramping is painful, it may cause lingering discomfort in that area for a couple of days.

If muscle spasms result from a neurological condition, they may cause symptoms such as:

Paralysis

Muscle pain

Muscle weakness

Coordination issues

Numbness

Difficulty sleeping

Vision issues

Experts aren’t sure why some people get muscle spasms more than others. However, possible causes can include:

Dehydration

Muscle fatigue

Exercising in extreme heat, which causes heat cramps

Not enough stretching

Electrolyte imbalance

Stress

Too much high-intensity exercise

A healthcare provider can diagnose muscle spasm by reviewing a person’s health history and medications, as well as asking questions that include:

How bad is the pain?

How long do the cramps last?

When do muscle spasms usually happen?

What do the muscle spasms feel like?

When did the muscle spasms start?

There is no pill or injection used to treat and relieve muscle spasms. However, some things can be done to try and stop muscle cramps, including:

Massage the affected areas with your hands or a massage roller

Stretch the affected area

Stand up and walk around

Apply heat or ice

Take over-the-counter (OTC) pain relievers such as ibuprofen or acetaminophen

Muscle spasms can happen at any time, and because they are so predictable, they can be difficult to prevent. Unfortunately, there are risk factors that can’t be avoided, such as your age. However, there are things you can do to reduce your risk, including:

Stretching your muscles regularly

Performing flexibility exercises

Drinking a lot of water

Wearing shoes that fit properly

Avoiding exercising in extreme heat

Working toward better overall fitness

Staying at a weight that is healthy for you

Avoiding medications that may cause muscle spasms as a side effect

Stretching your muscles before going to sleep

Using pillows to keep your toes pointed upward if you sleep on your back or letting your feet hang over the end of the bed if you sleep on your chest, to prevent leg cramps

If you are experiencing muscle spasms, you can schedule an appointment at Jamaica Hospital Medical Center’s Ambulatory Care Center. Please call (718) 206-7001.

Herniated Disc

Posted on March 3, 2026 by Xavia Malcolm

A herniated disc occurs when one of the discs in the spine tears or ruptures, allowing the jelly-like substance, or nucleus, in the disc to leak and irritate surrounding nerves.

A herniated disc can affect any part of the spine; however, this problem is most likely to occur in the lower spine. Herniated discs in the lumbar spine (the lower back) typically result in symptoms that affect the legs, feet, lower back, or buttocks. A common cause of lower back pain is a herniated disc. This pain is often described as sharp and radiating. In addition to lower back pain, a herniated disc can also cause leg pain, or sciatica.

A herniated disc in the cervical spine (the neck) may lead to neck pain, pain between the shoulder blades, or pain in the arms, hands, or fingers. Herniation in the neck or lower spine may also result in numbness, tingling, or muscle weakness, and in some instances bladder problems.

Herniated discs can be caused by age-related weakening or wear and tear of the discs; this is called disc degeneration. Other causes include:

Sudden or traumatic injuries
Repeated minor injuries
Repeated bending, strain, or twisting
Improper lifting of heavy objects
Poor posture
Obesity or excess body weight

Some people are at risk of getting a herniated disc more than others. Risk factors include:

Living a sedentary life
Being overweight
Smoking
Working in a career that requires frequent heavy lifting
Having a previously herniated disc
Having close blood relatives with spinal disc problems
Having a connective tissue disorder
Being seated for long periods

Most herniated discs heal on their own; however, in some instances, they may not. Symptoms of a herniated disc can worsen over time if left untreated, leading to complications such as bladder or bowel dysfunction, significant tingling, numbness, or weakness. It is advisable that you see a doctor if you are experiencing these complications.

Your physician may perform a thorough physical examination and order neurological examinations, imaging tests, or nerve tests to help diagnose a herniated disc. Once diagnosed, treatment may involve medications, physical therapy, spinal injections, or surgery.

To schedule an appointment with a doctor at Jamaica Hospital Medical Center, please call 718- 206-7001.