Treatment of Multiple System Atrophy in REM Sleep Behavior Disorder
REM sleep behavior disorder (RBD) is a common and clinically significant complication in patients with multiple system atrophy. Its presence requires a targeted pharmacological approach alongside the broader management of MSA.
Clinical scenario
RBD is characterized by the loss of muscle atonia during REM sleep with abnormal behaviors, often as dream enactment. This manifestation is common in patients with multiple system atrophy and warrants dedicated treatment.
Treatment approach
Management targets the abnormal sleep behaviors directly with bedtime pharmacotherapy. A specific first-line agent is used, with the option to add a second agent in combination — though the safety profile of combination use in MSA patients involves particular considerations that inform prescribing. Full guidance is in the complete protocol.
References
- RBD is characterized by the loss of muscle atonia during REM sleep with abnormal behaviors (often as dream enactment), which is common in patients with multiple system atrophy.
- Hence, melatonin is the first-line therapy, but it can be combined with clonazepam if needed.
DOI: 10.1212/cont.0000000000001598
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