Schmidt Markus H, Koshal Vipin B, Schmidt Helmut S
Ohio Sleep Medicine and Neuroscience Institute, Dublin, OH 43017, USA.
Sleep Med. 2006 Aug;7(5):418-23. doi: 10.1016/j.sleep.2006.03.018. Epub 2006 Jul 3.
Rapid eye movement (REM) sleep behavior disorder (RBD) has a known association with other medical conditions, including narcolepsy and neurodegenerative diseases such as synuclienopathies. RBD is currently treated with clonazepam as a first-line therapy. Recent research suggests that the pathophysiology underlying RBD may involve a dopaminergic deficiency, given its association with Parkinson syndromes and restless legs syndrome (RLS). We report on the efficacy of pramipexole, a dopaminergic D2-3 receptor agonist, in the treatment of RBD.
The first 10 consecutive patients presenting with a history and polysomnographically confirmed RBD were given pramipexole as either a single dose before bedtime or as a divided dose regimen with the first dose given in the early evening and the second dose at bedtime. Medication was titrated to control RBD symptoms and the clinical response was monitored through interviews with the patient, spouse, and close family members during the course of the study at regularly scheduled follow-up visits.
The mean length of treatment was 13.1 months, and the average total evening dose of pramipexole at the end of the study was 0.89+/-0.31 mg. A divided dose regimen of pramipexole was used in 56% of patients remaining on pramipexole. We found that 89% of patients experienced either a moderate reduction or complete resolution in the frequency of RBD symptoms throughout the duration of the study. Moreover, 67% reported at least a moderate reduction in the severity of remaining symptoms.
Pramipexole markedly reduced the frequency and severity of RBD symptoms and appeared to maintain efficacy for up to 25 months as assessed at follow-up visits. Clonazepam may have numerous unwanted side effects in the elderly or narcoleptics with RBD, such as prominent sedation and the potential exacerbation of underlying obstructive breathing in sleep. The potential role of pramipexole in improving RBD and its associated dopamine deficient syndromes warrants further research in the use of dopaminergic agonists as a potential first-line alternative therapy for RBD.
快速眼动（REM）睡眠行为障碍（RBD）与其他医学状况存在已知关联，包括发作性睡病以及诸如突触核蛋白病等神经退行性疾病。RBD目前以氯硝西泮作为一线治疗药物。近期研究表明，鉴于RBD与帕金森综合征及不宁腿综合征（RLS）相关，其潜在病理生理学可能涉及多巴胺能缺乏。我们报告了多巴胺能D2 - 3受体激动剂普拉克索治疗RBD的疗效。
连续纳入的首批10例有RBD病史且经多导睡眠图证实的患者，给予普拉克索，要么在睡前单次给药，要么采用分次给药方案，第一剂在傍晚服用，第二剂在睡前服用。药物剂量根据控制RBD症状的需要进行滴定，在研究过程中，通过在定期随访时与患者、配偶及近亲的访谈来监测临床反应。
平均治疗时长为13.1个月，研究结束时普拉克索的平均傍晚总剂量为0.89±0.31毫克。在继续使用普拉克索的患者中，56%采用了分次给药方案。我们发现，89%的患者在整个研究期间RBD症状发作频率出现中度减轻或完全缓解。此外，67%的患者报告剩余症状严重程度至少有中度减轻。
普拉克索显著降低了RBD症状的发作频率和严重程度，且在随访评估中显示，其疗效可持续长达25个月。氯硝西泮在患有RBD的老年人或发作性睡病患者中可能有诸多不良副作用，如显著的镇静作用以及可能加重潜在的睡眠呼吸障碍。普拉克索在改善RBD及其相关多巴胺缺乏综合征方面的潜在作用，值得进一步研究将多巴胺能激动剂作为RBD潜在一线替代疗法的应用情况。
