Sleep disturbance and rage attacks in opsoclonus-myoclonus syndrome: response to trazodone.
OBJECTIVE
Parents of children with opsoclonus-myoclonus syndrome (OMS) frequently describe poor sleep and rage attacks. We hypothesized that these manifestations are related and could result from underlying monoaminergic dysfunction.


METHODS
We clinically characterized the sleep and behavioral characteristics of 51 young children with OMS; 19 of those with the most disruptive sleep patterns were treated with trazodone, a soporific serotonergic agent.


RESULTS
Sleep disturbances, including prolonged sleep latency, fragmented sleep, reduced quantity of sleep, snoring, and non-restorative sleep, were reported in 32 children, and frequent rage attacks were reported in 25. In 59% of the poor sleepers, parents felt that the problem was severe enough to warrant treatment. Children sleeping <10 hours/night had a higher rage frequency than those who slept more. Of the children who required trazodone, 84% were receiving corticosteroids or adrenocorticotropic hormone (corticotrophin), compared with 37% in the subgroup with normal sleep. Trazodone (3.0 +/- 0.4 mg/kg/day) improved sleep and behavior in 95% of the children, significantly increasing total sleep time by 72%, decreasing the number of awakenings by 76%, and reducing rage attacks by 33%.


CONCLUSIONS
Children with OMS exhibited multiple types of sleep disturbances, which contributed to rage attacks. Trazodone was effective in improving sleep and decreasing rage attacks and was well tolerated, even in toddlers.
Pranzatelli
Michael R
MR
National Pediatric Myoclonus Center, Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9643, USA. mpranzatelli@siumed.edu
Tate
Elizabeth D
ED
Dukart
William S
WS
Flint
Mary Jo
MJ
Hoffman
Michael T
MT
Oksa
Amy E
AE
D000293:Adolescent; D000342:Affective Symptoms / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020361:Paraneoplastic Syndromes, Nervous System / Q000523:psychology*; D011889:Rage; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000209:etiology; D014196:Trazodone / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone