The treatment of choice for RBD is clonazepam, a benzodiazepine, although the mechanism is unknown and there are no controlled trials (13). Other drugs thought to be helpful for RBD include pramipexole, levodopa, carbamazepine, donepezil, and melatonin (64,89-91). Caution needs to be exercised with the use of clonazepam, as in some cases, RBD may be confused with sleep apnea, which can be worsened by clonazepam. Nighttime dosing with drugs such as selegiline may aggravate RBD. Others have reported a paradoxical worsening of RBD with deep brain stimulation (DBS) of the subthalamic nucleus (STN) (92).
RLS may complicate PD and cause significant sleep disruption, and there are no trials investigating treatment of RLS in PD. In some cases, targeted treatment with a long-acting dopamine agonist such as cabergoline, given at nighttime, may be effective (84,85). The role of drugs, such as the rotigotine transdermal patch or the prolonged release formulation of ropinirole, is being investigated. In severe cases, hospital admission with overnight apomorphine infusion may be required (86).
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