Beneficial Effects of Ramelteon on Rapid Eye Movement Sleep Behavior Disorder Associated with Parkinson's Disease - Results of a Multicenter Open Trial

Kashihara, Kenichi; Nomura, Takashi; Maeda, Tetsuya; Tsuboi, Yoshio; Mishima, Takayasu; Takigawa, Hiroshi; Nakashima, Kenichiro

doi:10.2169/internalmedicine.55.5464

Cited by 49 publications

(45 citation statements)

References 29 publications

(30 reference statements)

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“…Interventional studies have provided insufficient evidence to suggest that pharmacotherapy improves insomnia associated with PD. In this context, nonbenzodiazepine hypnotic, sedative atypical antipsychotic, anti‐depressive, dopaminergic agents, and melatonin have been tested (Calandra‐Buonaura et al, ; Dowling et al, ; Juri, Chaná, Tapia, Kunstmann, & Parrao, ; Kashihara et al, ; Medeiros et al, ; Melone et al, ; Menza et al, ; Pierantozzi et al, ; Poewe et al, ; Ray Chaudhuri et al, ; Rios Romenets et al, ). Despite this insufficient therapeutic evidence, sedative agents are still and frequently prescribed to manage sleep complaint in patients with PD (Lin et al, ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single‐case design with multiple baselines

et al. 2019

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Objective To test the efficacy of cognitive behavioral therapy for insomnia (CBT‐i) in Parkinson's Disease (PD) and to evaluate its impact on indices of daytime and psychological functioning. Method Fifteen patients with insomnia disorder (ID) comorbid to PD were enrolled in a single‐case design with multiple baselines. Total wake time, sleep efficiency, and daytime sleepiness were recorded on a sleep diary. Self‐reported measures of insomnia, anxiety and depressive symptoms, health‐related quality of life, and psychological variables perpetuating ID were completed. All patients also underwent a clinical interview for ID diagnosis. Results CBT‐i was associated with significant changes in sleep variables and ID criteria. Significant positive treatment‐related effects were also noted for all indices of daytime and psychological functioning, and for variables perpetuating ID. All of these improvements were well maintained at 3‐month follow‐up. Conclusion CBT‐i is a promising therapeutic avenue for patients with PD.

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Section: Introductionmentioning

confidence: 99%

Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single‐case design with multiple baselines

et al. 2019

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“…This combination of factors accentuates depressive symptoms, as well as oxidative stress and inflammation in the CNS [38,39]. A promising drug for treating circadian rhythm in psychiatric diseases is ramelteon (RMT), a melatonin receptor agonist [40]. Previous evidence indicates that RMT has neuroprotective, antioxidant, and anti-inflammatory activities [41].…”

Section: Oxidative Medicine and Cellular Longevitymentioning

confidence: 99%

Targeting Inflammatory-Mitochondrial Response in Major Depression: Current Evidence and Further Challenges

Visentin

Colombo

Scotton

et al. 2020

Oxidative Medicine and Cellular Longevity

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The prevalence of psychiatric disorders has increased in recent years. Among existing mental disorders, major depressive disorder (MDD) has emerged as one of the leading causes of disability worldwide, affecting individuals throughout their lives. Currently, MDD affects 15% of adults in the Americas. Over the past 50 years, pharmacotherapy, psychotherapy, and brain stimulation have been used to treat MDD. The most common approach is still pharmacotherapy; however, studies show that about 40% of patients are refractory to existing treatments. Although the monoamine hypothesis has been widely accepted as a molecular mechanism to explain the etiology of depression, its relationship with other biochemical phenomena remains only partially understood. This is the case of the link between MDD and inflammation, mitochondrial dysfunction, and oxidative stress. Studies have found that depressive patients usually exhibit altered inflammatory markers, mitochondrial membrane depolarization, oxidized mitochondrial DNA, and thus high levels of both central and peripheral reactive oxygen species (ROS). The effect of antidepressants on these events remains unclear. Nevertheless, the effects of ROS on the brain are well known, including lipid peroxidation of neuronal membranes, accumulation of peroxidation products in neurons, protein and DNA damage, reduced antioxidant defenses, apoptosis induction, and neuroinflammation. Antioxidants such as ascorbic acid, tocopherols, and coenzyme Q have shown promise in some depressive patients, but without consensus on their efficacy. Hence, this paper provides a review of MDD and its association with inflammation, mitochondrial dysfunction, and oxidative stress and is aimed at thoroughly discussing the putative links between these events, which may contribute to the design and development of new therapeutic approaches for patients.

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“…Higher doses of melatonin at bedtime (6–15 mg) restore REM atonia in association with disappearance of RBD symptoms [69]. An open-label clinical trial of the melatonin receptor agonist, ramelteon, demonstrated improvements of RBD in a cohort of 35 PD patients with co-existent sleep disturbances [70]. …”

Section: Pharmacologic Therapiesmentioning

confidence: 99%

Treatment of Sleep Dysfunction in Parkinson’s Disease

Amara

Chahine

Videnović

2017

Curr Treat Options Neurol

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Impaired sleep and alertness affect the majority of Parkinson's disease (PD) patients, negatively impacting safety and quality of life. The etiology of impaired sleep-wake cycle in PD is multifactorial and encompasses medication side effects, nocturnal PD motor symptoms, and presence of co-existent sleep and neuropsychiatric disorders. The primary neurodegenerative process of PD involves brain regions that regulate the sleep-wake cycle, such as brainstem and hypothalamic nuclei. Sleep disorders in PD include insomnia, REM sleep behavior disorder (RBD), sleep disordered breathing (SDB), restless legs syndrome (RLS), and circadian disruption. Despite its high prevalence in the PD population, there is a paucity of clinical studies that have investigated treatment of sleep dysfunction associated with PD. Therefore, we aim to review available evidence and outline treatment strategies for improvement of disorders of sleep and wakefulness in PD patients. Evidence supporting the efficacy of pharmacological and non-pharmacological treatment strategies in PD is limited. There is thus a great need but also opportunity for development of well-designed clinical trials for impaired sleep and alertness in PD. Providing education about sleep hygiene and strategies for its implementation represents the initial step in management. Prompt diagnosis and treatment of co-existent primary sleep and psychiatric disorders are critical, as this may significantly improve sleep and alertness. While the optimal treatment for insomnia in PD has not been established, available strategies include cognitive-behavioral therapy, medications with soporific properties, and light therapy. Safety measures, clonazepam, and melatonin are the mainstay of treatment for RBD. Continuous positive airway pressure is an effective treatment for SDB in PD. The treatment algorithm for RLS associated with PD mirrors that used for idiopathic RLS. Circadian disruption has emerged as an important etiology of impaired sleep-wake cycles in PD, and circadian-based interventions hold promise for novel treatment approaches.

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Beneficial Effects of Ramelteon on Rapid Eye Movement Sleep Behavior Disorder Associated with Parkinson's Disease - Results of a Multicenter Open Trial

Cited by 49 publications

References 29 publications

Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single‐case design with multiple baselines

Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single‐case design with multiple baselines

Targeting Inflammatory-Mitochondrial Response in Major Depression: Current Evidence and Further Challenges

Treatment of Sleep Dysfunction in Parkinson’s Disease

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