Current Treatment Options for REM Sleep Behaviour Disorder

Abstract

The symptomatic treatment of REM sleep behaviour disorder (RBD) is very important to prevent sleep-related falls and/or injuries. Though clonazepam and melatonin are usually considered the first-line symptomatic therapy for RBD, their efficiency has not been proven by randomized clinical trials. The role of dopamine agonists in improving RBD symptoms is controversial, and rivastigmine, memantine, 5-hydroxytryptophan, and the herbal medicine yokukansan have shown some degree of efficacy in short- and medium-term randomized clinical trials involving a low number of patients. The development of potential preventive therapies against the phenoconversion of isolated RBD to synucleinopathies should be another important aim of RBD therapy. The design of long-term, multicentre, randomized, placebo-controlled clinical trials involving a large number of patients diagnosed with isolated RBD with polysomnographic confirmation, directed towards both symptomatic and preventive therapy for RBD, is warranted.

Sodium oxybate in treatment-resistant rapid-eye-movement sleep behavior disorder

“…There is currently no validated method to objectively monitor outcomes in RBD [ 28 ]. Other reports of video-PSG outcomes with SXB in iRBD [ 14 ] showed no effect; however, they used a different scoring method, only reporting severity, not number of episodes [ 29 ]. We applied the IRBDSG video scoring rules to measure RBD activity before and after treatment [ 17 ].…”

“…The literature on efficacy in RBD is limited to six patients with iRBD and one with PD-RBD [ 12–15 ]. Limited data suggest that SXB may selectively reduce most injurious and complex dream-enactment episodes [ 14 ]. In our dataset, mild episode severity did not predict treatment failure.…”

Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

“…RSWA seemed to improve significantly with the use of ramelteon (MLT agonist); dopamine agonists demonstrated, as expected, improvements of PLMS, but not of other PSG parameters. 27 Therefore, there is no doubt about the importance of carrying out further investigations on this topic, 29 aimed however at understanding how these drugs can act on the pathophysiology of iRBD.…”

“…Therefore, there is no doubt about the importance of carrying out further investigations on this topic, 29 aimed however at understanding how these drugs can act on the pathophysiology of iRBD.…”

The use of melatonin preparations in sleep disorders

“…Только три представляли собой рандомизированные клинические испытания с уровнем доказательности I и уровнем качества >50%. Одно из них включало короткую серию из 8 пациентов, получавших 3 мг мелатонина на ночь, которые имели значительное улучшение клинических и полисомнографических показателей при РПБС, и два других с участием 30 пациентов, получавших мелатонин пролонгированного действия в дозе 2-6 мг в день, у которых не было улучшения поведения во сне [37]. По сравнению с клоназепамом мелатонин также имеет благоприятный профиль безопасности и переносимости с ограниченным потенциалом лекарственного взаимодействия, что является важным фактором для пожилых людей с РПБС, получаю щих более 2 лекарственных препаратов [38].…”