Use of pramipexole in REM sleep behavior disorder: Results from a case series

Schmidt, Markus H.; Koshal, Vipin B.; Schmidt, Helmut S.

doi:10.1016/j.sleep.2006.03.018

Cited by 105 publications

(47 citation statements)

References 11 publications

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“…In contrast, consistent with previous studies (Fantini et al 2003;Schmidt et al 2006), the results of our study suggest that a low dose of pramipexole can be effective for reducing nightmares, engendering improvement in RBD symptoms in patients with idiopathic RBD. In this regard, the effect of pramipexole on idiopathic RBD might differ from that on secondary RBD in PD patients who are already taking high-dosage dopaminergic medication (Kumru et al 2008).…”

Section: Discussionsupporting

confidence: 90%

“…Fantini et al (2003) reported that 7 of 8 patients reported reduced RBD clinical manifestations after pramipexole treatment. Schmidt et al (2006) also reported that pramipexole mitigated the RBD symptom severity. However, to date, the mechanism of action of pramipexole on RBD symptoms remains unclear.…”

Section: Discussionmentioning

confidence: 90%

“…According to a recent review of the effectiveness of interventions in RBD (Aurora et al 2010), only two reports have described published studies that evaluated the effectiveness of pramipexole treatment on idiopathic RBD (Fantini et al 2003;Schmidt et al 2006). Fantini et al (2003) reported that 7 of 8 patients reported reduced RBD clinical manifestations after pramipexole treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Its frequency in RBD is higher than that seen in the normal population, especially during the REM sleep period (Fantini et al 2002). Although two previous case series investigated the effectiveness of pramipexole on RBD symptoms (Fantini et al 2003;Schmidt et al 2006), these studies did not respectively examine the effect of pramipexole on PLMS during non-REM (NREM) and REM sleep periods. Moreover, the pathophysiology of PLMS in idiopathic RBD remains unsolved.…”

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confidence: 99%

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Effectiveness of Pramipexole, a Dopamine Agonist, on Rapid Eye Movement Sleep Behavior Disorder

Sasai

Inoue

Matsuura

2012

Tohoku J. Exp. Med.

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Rapid eye movement (REM) sleep behavior disorder (RBD) is parasomnia characterized by REM sleep without atonia (RWA) and elaborate motor activity in association with dream mentation. Periodic leg movement during sleep (PLMS) is observed in a large share of patients with RBD, suggesting a common pathology: dopaminergic dysfunction. This study was undertaken to evaluate the effectiveness and mechanism of action of pramipexole, a dopamine agonist, on RBD symptoms. Fifteen patients (57-75 years old) with RBD with a PLMS index of more than 15 events/h shown by nocturnal polysomnography were enrolled. Sleep variables, the score of severity for RBD symptoms, REM density, and PLM index were compared before and after one month or more of consecutive pramipexole treatment. Correlation analysis was conducted between the rate of change in RBD symptoms and the rate of reduction of REM density. Fourteen patients with RBD (80.0%) achieved symptomatic improvement of RBD with pramipexole treatment, which reduced REM density and PLM index during non-REM sleep despite the unchanged amount of RWA. The rate of change in RBD symptoms correlated positively with the rate of REM density reduction. Significant reduction of the PLM index was observed in non-REM sleep but not in REM sleep. Periodic leg movement during sleep (PLMS) is often comorbid with RBD, suggesting a common pathogenesis of the two disorders. Its frequency in RBD is higher than that seen in the normal population, especially during the REM sleep period (Fantini et al. 2002). Although two previous case series investigated the effectiveness of pramipexole on RBD symptoms (Fantini et al. 2003;Schmidt et al. 2006), these studies did not respectively examine the effect of pramipexole on PLMS during non-REM (NREM) and REM sleep periods. Moreover, the pathophysiology of PLMS in idiopathic RBD remains unsolved.Episodes of violent behavior in RBD are mostly associated with nightmares. However, no report describes the effectiveness of pramipexole for alleviating nightmares in RBD or its relation to REM density, which possibly triggers dream imagery (Ogawa et al. 2005).To elucidate the mechanism of pramipexole action on the pathogenesis of RBD, we investigated its effects on RBD symptoms, with particular attention to REM-related parameters and PLMS in this pilot study. Methods Subjects

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effectiveness of Pramipexole, a Dopamine Agonist, on Rapid Eye Movement Sleep Behavior Disorder

Sasai

Inoue

Matsuura

2012

Tohoku J. Exp. Med.

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“…145 As in patients with idiopathic RBD, affected PD patients can often be treated successfully with clonazepam, and there are reports that donepezil, melatonin, and pramipexole may also be helpful. [146][147][148] Similar to RLS/PLMS, RBD may be caused or aggravated by antidepressants, 149 a fact that should be borne in mind by clinicians. As with any patient suffering from RBD, making the sleeping environment safe and protecting bed partners from inadvertent injury are of paramount importance.…”

Section: Rapid Eye Movement Sleep Behavior Disordermentioning

confidence: 99%

Non-motor Symptoms in Parkinson’s Disease

Uç¹,

Tippin²,

Chou³

et al. 2011

US Neurology

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In addition to typical motor dysfunction (parkinsonism), diverse non-motor symptoms (NMS) are frequently observed in patients with Parkinsons disease (PD). Some NMS may antedate the diagnosis of PD. Examples of NMS include cognitive impairment, autonomic dysfunction, visual dysfunction, sleep abnormalities, and psychiatric disorders. NMS are associated with wide-ranging abnormalities in extranigral dopaminergic systems and non-dopaminergic (e.g. cholinergic, noradrenergic, serotoninergic) systems. The type and severity of NMS vary based on age, disease severity, and predominant motor symptoms. NMS can be disabling and reduce quality of life. Treatment of NMS can be challenging. Some NMS are helped by dopaminergic treatment, whereas others can be induced or exacerbated by treatments that help the motor dysfunction. Physicians should probe their PD patients about their NMS and address them for better care. Clinical trials should incorporate NMS as outcomes for more meaningful conclusions on the effect of treatments under investigation.

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