Dementia with Lewy bodies (DLB) is often associated with REM sleep behavior disorders (RBD) characterized, in contrast to the usual paralysis of REM sleep, by violent motor and verbal activity.
The pharmacological management of RBD was investigated in three DLB patients treated with clonazepam, a benzodiazepine used as an antiepileptic, or donepezil, a cholinesterase inhibitor.
All three patients had marked improvement. The pharmacodynamic mechanisms underlying the efficacy of the two drugs might be due to facilitator effect on the pedunculopontine nucleus, a key structure in the physiology of REM sleep.
"ng them , although it should be used with caution in patients with dementia , disorders of gait or balance , or concomitant OSAS . Smaller beneficial effects have been reported for melatonin 3 – 12 mg ( Gagnon et al . , 2006 ) . Single case studies and small series have reported beneficial effects of clonidine ( Nash et al . , 2003 ) , donepezil ( Massironi et al . , 2003 ) and sodium oxybate ( Kosky et al . , 2008 ) . Drugs which can worsen RBD or provoke its symptoms include SSRIs , venlafaxine , mirtazapine , bisoprolol , and tra - madol ( Gagnon et al . , 2006 ) ."
[Show abstract][Hide abstract] ABSTRACT: Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.
Journal of Psychopharmacology 11/2010; 24(11):1577-601. DOI:10.1177/0269881110379307 · 3.59 Impact Factor
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