Raffaele Manni1, Gianpaolo Toscano2, Michele Terzaghi2. 1. Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Via Mondino, 27100, Pavia, Italy. raffaele.manni@mondino.it. 2. Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Via Mondino, 27100, Pavia, Italy.
Abstract
PURPOSE OF REVIEW: The purpose of this review was to discuss the currently available pharmacologic and non-pharmacologic treatment options for parasomnias. RECENT FINDINGS: Recent pathophysiological findings about sleep structure in parasomnias helped understanding several drug mechanisms of action. Serotoninergic theory accounts for the effect of serotoninergic drugs. Study about spectral analysis of sleep showed the effect of clonazepam on spectral bands. Cannabinoids proved to be effective in some of parasomnias, as in many other neurological disorders. A series of therapeutic strategies were analyzed and compared. Benzodiazepines, antidepressant drugs, and L-5-hydroxytryptophan may be beneficial in DOA. SSRI and topiramate are effective in SRED. RBD responds to clonazepam, melatonin, and to a lesser extent to dopaminergic and anticholinergic agents. Prazosin and cannabinoids are effective in nightmare disorder. Sleep paralysis may respond to antidepressant agents. Tricyclic antidepressant may be effective in sleep-related hallucinations and exploding head syndrome. Sleep enuresis may be successfully treated with desmopressin, anticholinergic drugs, and imipramine.
PURPOSE OF REVIEW: The purpose of this review was to discuss the currently available pharmacologic and non-pharmacologic treatment options for parasomnias. RECENT FINDINGS: Recent pathophysiological findings about sleep structure in parasomnias helped understanding several drug mechanisms of action. Serotoninergic theory accounts for the effect of serotoninergic drugs. Study about spectral analysis of sleep showed the effect of clonazepam on spectral bands. Cannabinoids proved to be effective in some of parasomnias, as in many other neurological disorders. A series of therapeutic strategies were analyzed and compared. Benzodiazepines, antidepressant drugs, and L-5-hydroxytryptophan may be beneficial in DOA. SSRI and topiramate are effective in SRED. RBD responds to clonazepam, melatonin, and to a lesser extent to dopaminergic and anticholinergic agents. Prazosin and cannabinoids are effective in nightmare disorder. Sleep paralysis may respond to antidepressant agents. Tricyclic antidepressant may be effective in sleep-related hallucinations and exploding head syndrome. Sleep enuresis may be successfully treated with desmopressin, anticholinergic drugs, and imipramine.
Entities:
Keywords:
Disorders of arousals (DOA); Pharmacologic treatment; REM parasomnia
Authors: Stuart J McCarter; Christopher L Boswell; Erik K St Louis; Lucas G Dueffert; Nancy Slocumb; Bradley F Boeve; Michael H Silber; Eric J Olson; Maja Tippmann-Peikert Journal: Sleep Med Date: 2013-01-23 Impact factor: 3.492