Melatonin viable alternative for REM sleep behavior disorder treatment

By Lucy Piper, Senior medwireNews Reporter

Clonazepam and melatonin appear to be equally effective for the treatment of rapid eye movement (REM) sleep behavior disorder (RBD) symptoms, although melatonin may be better tolerated, a naturalistic clinical study shows.

"Given these findings, melatonin may be considered a reasonable treatment alternative to clonazepam, particularly for older or neurologically impaired RBD patients who may be more sensitive to adverse effects of treatment," say Erik St Louis, from the Mayo Clinic College of Medicine in Rochester Minnesota, USA, and colleagues.

The researchers surveyed and reviewed the medical records of consecutive RBD patients seen at the clinic between 2008 and 2010. In all, 45 (84.9%) of 53 respondents were analyzed.

The patients were aged an average of 65.8 years and 77.8% were men. Neurodegenerative disorders were seen in 53% of patients and 56% were taking antidepressants.

Melatonin was taken by 25 of the patients, at a median dose of 6 mg/day, while 18 patients were taking clonazepam, at a median dose of 0.5 mg/day, and two patients received both medications as initial treatment.

Most of the patients continued to have RBD symptoms, including dream enactment behavior and abnormal, excessive motor activity during REM sleep, following treatment, with only three patients in each treatment group reporting complete suppression of RBD symptoms.

But both treatments were effective in reducing the frequency and severity of RBD symptoms, as rated on an RBD visual analog scale (VAS), as well as the risk for injury.

The reduction in VAS frequency-severity rating fell was similar for the two treatments, dropping from 6.68 before treatment to 4.22 afterwards in melatonin-treated patients and from 6.53 to 4.15 in clonazepam-treated patients.

Both melatonin and clonazepam treatment also reduced the rate of injuries (by 44% and 28%, respectively), falls (40% and 34%), and dream enactment behaviors (40% and 50%). All the improvements were significant for melatonin, whereas only the improvement in dream enactment behaviors was significant for clonazepam, which the researchers suggest may be due to the small sample size.

Side effects were more common among clonazepam-treated patients than those taking melatonin, with higher rates of dizziness and unsteadiness, but there was no difference in retention rates, with a respective 22% and 28% of patients discontinuing treatment. Discontinuations were mainly due to lack of efficacy in the case of melatonin and side effects for clonazepam.

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