title: Melatonin therapy for REM sleep behavior disorder: a critical review of evidence.
abstract: Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with dream enactment often involving violent or potentially injurious behaviors during REM sleep that is strongly associated with synucleinopathy neurodegeneration. Clonazepam has long been suggested as the first-line treatment option for RBD. However, evidence supporting melatonin therapy is expanding. Melatonin appears to be beneficial for the management of RBD with reductions in clinical behavioral outcomes and decrease in muscle tonicity during REM sleep. Melatonin also has a favorable safety and tolerability profile over clonazepam with limited potential for drug-drug interactions, an important consideration especially in elderly individuals with RBD receiving polypharmacy. Prospective clinical trials are necessary to establish the evidence basis for melatonin and clonazepam as RBD therapies.
authors.affiliation: Department of Pharmacy, Shodair Children's Hospital, 2755 Colonial Dr, Helena, MT 59601, USA. Electronic address: imcgrane@shodair.org.
authors.forename: Ian R
authors.initials: IR
authors.lastname: McGrane
authors.affiliation: Department of Pharmacy, Mayo Clinic College of Medicine, Mayo Clinic, 1216 2nd Street Southwest, Rochester, MN 55902, USA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Leung
authors.affiliation: Section of Sleep Neurology, Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, 200 1st Street Southwest, Rochester, MN 55905, USA.
authors.forename: Erik K
authors.initials: EK
authors.lastname: St Louis
authors.affiliation: Section of Sleep Neurology, Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, 200 1st Street Southwest, Rochester, MN 55905, USA.
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Boeve
mesh_terms: D002492:Central Nervous System Depressants / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008550:Melatonin / Q000494:pharmacology / Q000627:therapeutic use*; D020187:REM Sleep Behavior Disorder / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D002492:Central Nervous System Depressants; D008550:Melatonin
keywords: Calmodulin; Drug therapy; Melatonin; Parasomnia; REM sleep behavior disorder