title: Biperiden for treatment of somnambulism in adolescents and adults with or without epilepsy: clinical observations.
abstract: BACKGROUND
  Sleepwalking in adolescents and adults may lead to serious injuries and require treatment. Anecdotal treatment recommendations include benzodiazepines (which also work in focal seizures of the frontal lobe that are an important differential diagnosis), imipramine and amitriptyline.
  
  
  METHODS
  We assessed in a follow-up study of 4 years (medium, range: 2-7 years) the usefulness of the antiparkinsonian drug biperiden (Akineton©), an acetylcholine antagonist with high affinity for muscarinic M1-type receptors, in four consecutive cases of arousal disorder with sleepwalking and confusional behavior in adolescents and adults with or without epilepsy who did not respond to diazepam, clonazepam or amitriptyline.
  
  
  RESULTS
  The adjunctive use of biperiden was associated with reduction or remission of sleepwalking episodes in four consecutive treatment-refractory cases of arousal disorder with sleepwalking and confusional behavior. In contrast, biperiden showed no effect in a patient with REM behavioral disorder.
  
  
  CONCLUSIONS
  Although our observations do not and cannot establish the efficacy or safety of biperiden, it may be useful to consider biperiden for treatment of sleepwalking, if needed. A putative cholinergic mechanism of arousal disorders, including sleepwalking, provides a reasonable hypothesis why the anticholinergic agent biperiden might work. Evidence for efficacy and safety from randomized controlled trials is needed to confirm our preliminary observations.
authors.affiliation: Department for Psychophysiology and Organic Mental Disorders, University Psychiatric Clinic Vrapce, Zagreb, Croatia.
authors.forename: Danilo
authors.initials: D
authors.lastname: Hodoba
authors.forename: Dieter
authors.initials: D
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D001712:Biperiden / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D004827:Epilepsy / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000187:drug effects; D013009:Somnambulism / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018680:Cholinergic Antagonists; D001712:Biperiden