Melatonin for Rapid Eye Movement Sleep Behavior Disorder in Parkinson's disease: A Randomised Controlled Trial

Gilat, Moran; Jackson, Alessandra Coeytaux; Marshall, Nathaniel S.; Hammond, Deborah; Mullins, Anna; Hall, Julie M.; Fang, Bernard; Yee, Brendon J.; Wong, Keith; Grunstein, Ron; Lewis, Simon J.G.

doi:10.1002/mds.27886

Cited by 100 publications

(107 citation statements)

References 32 publications

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“…However, a recent placebo-controlled trial found melatonin use at either 2 or 6 mg/night improved self-reported measures such as daytime sleepiness, sleep quality or dream enactment behaviors ( 105 ). A recent randomized, controlled trial of melatonin in a cohort of PD patients with RBD also found no effect of melatonin on RBD symptom frequency or severity ( 106 ), suggesting melatonin may be less effective at controlling RBD symptoms in the context of advanced neurodegeneration. The efficacy of melatonergic compounds such as the melatonin receptor agonist Ramelteon also do not significantly improve RBD symptom severity ( 107 ).…”

Section: Pharmacologicalmentioning

confidence: 99%

A Neurologist's Guide to REM Sleep Behavior Disorder

et al. 2020

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REM Sleep Behavior Disorder (RBD) is a chronic sleep condition characterized by dream enactment and loss of REM atonia. Individuals often present to clinic with complaints of injury to themselves or their bed-partner due to violent movements during sleep. RBD patients have a high risk of developing one of the neurodegenerative α-synucleinopathy diseases: over 70% will develop parkinsonism or dementia within 12 years of their diagnosis. RBD patients also exhibit accelerated disease progression and a more severe phenotype than α-synucleinopathy sufferers without RBD. The disease's low prevalence and the relatively limited awareness of the condition amongst medical professionals makes the diagnosis and treatment of RBD challenging. Uncertainty in patient management is further exacerbated by a lack of clinical guidelines for RBD patient care. There are no binary prognostic markers for RBD disease course and there are no clinical guidelines for neurodegeneration scaling or tracking in these patients. Both clinicians and patients are therefore forced to deal with uncertain outcomes. In this review, we summarize RBD pathology and differential diagnoses, diagnostic, and treatment guidelines as well as prognostic recommendations with a look to current research in the scientific field. We aim to raise awareness and develop a framework for best practice for RBD patient management.

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Section: Pharmacologicalmentioning

confidence: 99%

A Neurologist's Guide to REM Sleep Behavior Disorder

et al. 2020

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“…Some studies have shown that some lifestyle interventions could improve the quality of life of PD patients, such as behavior therapy, sleep improvement, mood improvement, and physical exercise (2)(3)(4)(5). However, few studies have examined the effect of nutritional status on the quality of life of patients with PD (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors for Malnutrition in Patients With Parkinson's Disease

et al. 2020

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Objectives: This study aimed to investigate the relationship between nutritional status and Parkinson's disease (PD) features.Methods: The cohort was composed of 556 Parkinson's patients who were admitted to the hospital. Patients were categorized as normal nutrition or at risk of malnutrition/already malnourished. Questionnaires, physical examinations, and biochemical tests were conducted. The relationship between nutrition status and PD was analyzed using t-tests, χ2-tests, and logistic regression models.Results: The prevalence of malnutrition [defined as a Mini Nutritional Assessment (MNA) score <17] was 39.2%, and 30.3% of patients were at risk of malnutrition (17 ≤ MNA score ≤ 23.5). There was no difference in gender and age between the different nutrition groups (P < 0.05). Patients at risk of malnutrition and those who were malnourished had a longer course of disease, more severe motor symptoms, a higher stage of PD according to the Hoehn and Yahr (H-Y) classification, a lower body mass index (BMI) index, a lower cognitive score, higher levels of depression and anxiety, and more serious non-motor symptoms (P < 0.05) than patients with normal nutrition. There were differences in adenosine deaminase, albumin, phosphorus, chlorine, total protein, and uric acid between the two groups (P < 0.05). High Unified PD Rating Scale (UPDRS-III) scores, high H-Y stages, and dyskinesia were risk factors for malnutrition in PD patients, while high levels of total protein, uric acid, and chlorine were protective factors that led to good nutrition (P < 0.05).Conclusions: Our results showed that dyskinesia, disease severity, total protein levels, uric acid levels, and chlorine levels were associated with nutritional status among Chinese PD patients. The findings of this study indicate the significance of the early detection and prevention of malnutrition to improve the quality of life of PD patients.

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“…Based on these results, a clinical consensus recommended the use of melatonin in RBD at level B (Aurora et al, 2010). However, a negative result was recently published in a randomized, double-blind, placebo controlled, parallel-group trial of 30 RBD patients treated unsuccessfully for 8°weeks with 4 mg prolonged release melatonin (Gilat et al, 2020). Therefore, more high-quality studies are needed in this respect.…”

Section: Clinical Use Of Melatonin In Parkinson's Disease and Rbdmentioning

confidence: 99%

Melatonin as a Chronobiotic and Cytoprotective Agent in Parkinson’s Disease

Pérez-Lloret

Cardinali

2021

Front. Pharmacol.

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This article discusses the role that melatonin may have in the prevention and treatment of Parkinson’s disease (PD). In parkinsonian patients circulating melatonin levels are consistently disrupted and the potential therapeutic value of melatonin on sleep disorders in PD was examined in a limited number of clinical studies using 2–5 mg/day melatonin at bedtime. The low levels of melatonin MT1 and MT2 receptor density in substantia nigra and amygdala found in PD patients supported the hypothesis that the altered sleep/wake cycle seen in PD could be due to a disrupted melatonergic system. Motor symptomatology is seen in PD patients when about 75% of the dopaminergic cells in the substantia nigra pars compacta region degenerate. Nevertheless, symptoms like rapid eye movement (REM) sleep behavior disorder (RBD), hyposmia or depression may precede the onset of motor symptoms in PD for years and are index of worse prognosis. Indeed, RBD patients may evolve to an α-synucleinopathy within 10 years of RBD onset. Daily bedtime administration of 3–12 mg of melatonin has been demonstrated effective in RDB treatment and may halt neurodegeneration to PD. In studies on animal models of PD melatonin was effective to curtail symptomatology in doses that allometrically projected to humans were in the 40–100 mg/day range, rarely employed clinically. Therefore, double-blind, placebo-controlled clinical studies are urgently needed in this respect.

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Melatonin for Rapid Eye Movement Sleep Behavior Disorder in Parkinson's disease: A Randomised Controlled Trial

Cited by 100 publications

References 32 publications

A Neurologist's Guide to REM Sleep Behavior Disorder

A Neurologist's Guide to REM Sleep Behavior Disorder

Prevalence and Risk Factors for Malnutrition in Patients With Parkinson's Disease

Melatonin as a Chronobiotic and Cytoprotective Agent in Parkinson’s Disease

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