title: Sodium oxybate for idiopathic REM sleep behavior disorder: a report on two patients.
abstract: BACKGROUND
  REM-sleep behavior disorder (RBD) therapy is based on small to medium-sized case series, as no large controlled clinical trials have been performed. The most used and widely recognized effective drugs are clonazepam and melatonin, with anecdotal reports on the potential benefit of other drug classes.
  
  
  METHODS
  We report on two patients suffering from idiopathic RBD presenting with almost nightly complex and violent episodes, refractory to conventional drugs. Both patients, after informed consent, were treated off-label with sodium oxybate in add-on therapy. We followed up the patients in order to assess treatment efficacy by means of clinical interview, visual analog scales (VAS) for frequency and severity, Clinical Global Impression (CGI) improvement scale and efficacy index, video-polysomnography and at-home actigraphy.
  
  
  RESULTS
  Sodium oxybate intake was well tolerated and effective in reducing the number and intensity of RBD episodes; patients reported no new traumatic episodes. Results were confirmed by bed-partner reports, VAS, CGI improvement scale and efficacy index, and at-home actigraphic monitoring, the latter showing a trend of improvement in nocturnal sleep quality and reduction in motor activity, compared to the baseline. Nevertheless, video-polysomnography did not show a clear beneficial effect on sleep-related electromyographic parameters.
  
  
  CONCLUSIONS
  Our cases suggest that sodium oxybate can be an effective add-on option for the treatment of idiopathic RBD refractory to conventional therapies. The lack of improvement of polysomnographic parameters suggests caution in considering only polysomnographic data as endpoints in the assessment of the efficacy of therapies for RBD, and that long-term home-based assessment seems a promising tool.
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Keivan Kaveh
authors.initials: KK
authors.lastname: Moghadam
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, ASL di Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pizza
authors.affiliation: Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Primavera
authors.affiliation: Sleep Research Centre, Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ferri
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, ASL di Bologna, Bologna, Italy. Electronic address: giuseppe.plazzi@unibo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Plazzi
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000187:drug effects / Q000379:methods; D020187:REM Sleep Behavior Disorder / Q000188:drug therapy*; D012978:Sodium Oxybate / Q000627:therapeutic use*
chemical_list: D018686:Anesthetics, Intravenous; D012978:Sodium Oxybate
keywords: Actigraphy; GHB; RBD; Sodium oxybate; Treatment; Video-polysomnography