A prospective, naturalistic follow-up study of treatment outcomes with clonazepam in rapid eye movement sleep behavior disorder

Li, Shirley Xin; Lam, Siu Ping; Zhang, Jihui; Yu, Manda; Chan, Joey Wing Yan; Liu, Yaping; Lam, Venny; Ho, Crover Kwok Wah; Zhou, Junying; Wing, Yun Kwok

doi:10.1016/j.sleep.2015.12.020

Cited by 89 publications

(101 citation statements)

References 32 publications

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“…This design was selected to better follow the naturalistic evolution of RBD. One factor that could hamper the observation of the naturalistic evolution of RBD symptoms is the fact that the symptoms could be resolved with medication (Schenck et al 2013b;Li et al 2016). Because of this favorable action of medication, it is often difficult to observe the natural progression of symptom change.…”

Section: Discussionmentioning

confidence: 99%

Changes in the symptom frequency of rapid eye movement sleep behavior disorder according to disease duration

Sumi

Matsuo

Nakabayashi

et al. 2017

Sleep Science Practice

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Background: This descriptive study was conducted to examine the changes in the symptom frequency in patients with rapid eye movement (REM) sleep behavior disorder (RBD) without medical intervention, in order to determine the association of RBD symptom frequency with disease duration. Methods: Data were collected from 70 consecutive RBD patients who visited the Sleep Clinic in Shiga University of Medical Science. RBD symptom frequencies at the first visit to the clinic were quantified based on the reports by the patients and their family members. For quality assurance, patients living alone or those with cognitive decline were excluded. Finally, 50 patients with family-confirmed symptom history were enrolled. The symptom frequencies were converted to a unit that reflects the estimated number of nights in a year affected by RBD (NAR). Using NAR, we observed the relation between RBD symptom frequency and the disease duration. Results: Of the 50 patients, 41 were male and 9 were female, consistent with the male-dominant nature of this disease. The mean age at RBD onset was 62.2 ± 9.1 years, and the mean disease duration at the time of visit was 6.0 ± 4.9 years. The median symptom frequency was 50 NAR, with a 1st quantile value of 24 NAR and a 3rd quantile value of 115 NAR. When RBD symptom frequency was plotted against disease duration, we found that the frequency was lowest in the first 2 years of RBD (median, 18; range, 2-29 NAR), and higher frequencies were found in 2-year bin groups from 2 to 8 years after RBD onset (median, 60; range,. Intriguingly, after 8 years of RBD, the frequency returned to a level comparable to that in the first 2 years of RBD (median, 50; range, 12-100 NAR). Conclusions: There was no association between RBD symptom frequency and disease duration. RBD clinical symptoms could be less prominent when neural damage becomes severe. Therefore, a natural decrease in RBD symptom frequency may be indicative of progression of neurodegeneration.

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Section: Discussionmentioning

confidence: 99%

Changes in the symptom frequency of rapid eye movement sleep behavior disorder according to disease duration

Sumi

Matsuo

Nakabayashi

et al. 2017

Sleep Science Practice

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“…Clonazepam may exacerbate comorbid obstructive sleep apnea and cognitive impairment, so it should be used with caution in elderly patients, especially those with PD, DLB, or MSA. 145,146 Adverse effects include sedation, sexual dysfunction, and imbalance. Other RBD treatments with reported benefit for RBD in small uncontrolled case series include pramipexole, donepezil, ramelteon, Yi-Gan San, and cannabinoids, 141,149,150 and further evidence basis for the use of all symptomatic treatment of RBD is greatly needed.…”

Section: Rapid Eye Movement Sleep Behavior Disorder Treatmentmentioning

confidence: 99%

REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions

Louis

Boeve

2017

Mayo Clinic Proceedings

155

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Rapid eye movement sleep behavior disorder (RBD) is diagnosed by a clinical history of dream enactment accompanied by polysomnographic rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia). Rapid eye movement sleep behavior disorder is strongly associated with neurodegenerative disease, especially synucleinopathies such as Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. A history of RBD may begin several years to decades before onset of any clear daytime symptoms of motor, cognitive, or autonomic impairments, suggesting that RBD is the presenting manifestation of a neurodegenerative process. Evidence that RBD is a synlucleinopathy includes the frequent presence of subtle prodromal neurodegenerative abnormalities including hyposmia, constipation, and orthostatic hypotension, as well as abnormalities on various neuroimaging, neurophysiological, and autonomic tests. Up to 90.9% of patients with idiopathic RBD ultimately develop a defined neurodegenerative disease over longitudinal follow-up, although the prognosis for younger patients and antidepressant-associated RBD is less clear. Patients with RBD should be treated with either melatonin 3 to 12 mg or clonazepam 0.5 to 2.0 mg to reduce injury potential. Prospective outcome and treatment studies of RBD are necessary to enable accurate prognosis and better evidence for symptomatic therapy and future neuroprotective strategies.

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“…The hallmark of the diagnosis of REM sleep behavior disorder is the absence of atonia during REM sleep and "dream enactment" [35][36][37][38][39][40]. Reliable history has to be obtained from caregivers in order to give such diagnosis because not all patients are aware of themselves having this disorder.…”

Section: Rem Sleep Behavior Disorder (Rbd)mentioning

confidence: 99%

“…The highest level of evidence is provided in an uncontrolled trial in patients with DLB (n=7). RBD in general, not in the context of DLB, was studied in a placebo-controlled, randomized crossover study in patients with iRBD [36] and an observational study in patients with idiopathic RBD (Irbd) [37]. In the uncontrolled study, 7 patients with DLB-associated REM sleep behavior disorder among a group of 14 patients with other neurological diseases were started on melatonin 3-12 mg [35].…”

Section: Rem Sleep Behavior Disorder (Rbd)mentioning

confidence: 99%

See 1 more Smart Citation

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

Ouf¹,

Szigeti²

2017

J Alzheimers Dis Parkinsonism

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A prospective, naturalistic follow-up study of treatment outcomes with clonazepam in rapid eye movement sleep behavior disorder

Cited by 89 publications

References 32 publications

Changes in the symptom frequency of rapid eye movement sleep behavior disorder according to disease duration

Changes in the symptom frequency of rapid eye movement sleep behavior disorder according to disease duration

REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

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