Melatonin for RBD

[danielmd06]

I recall pediatric case studies from conferences where kids got melatonin 10 mg 30 minutes prior to bedtime for RBD in lieu of clonazepam.

Anyone tried this in adults?

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[neurologist]

Yes, RBD can be treated w/ melatonin. It's usually less effective than clonazepam, but every so often it can work.

I'm curious about the kids-with-RBD aspect. I've never seen real RBD in a peds patient. What age range? You sure it's RBD and not night terrors?

 

[danielmd06]

Yes, RBD can be treated w/ melatonin. It's usually less effective than clonazepam, but every so often it can work.

I'm curious about the kids-with-RBD aspect. I've never seen real RBD in a peds patient. What age range? You sure it's RBD and not night terrors?

Thanks neurologist. It was a pediatric presentation case at the AAN conference in Honolulu this year - not someone I have personally seen. The documentation provided for the seminar comments about melatonin being used to spare the children a benzo prescription. My memory is bad, but I'm guessing the girl was between 8 and 11.

 

[danielmd06]

Oh, and it was definitely not night terrors.

Curiously, I saw a second case (I think this one was in Honolulu, too) of a girl in a similar age range that was diagnosed with nocturnal seizures (in REM sleep no less!) that included a video.

In the video, the girl was asleep in REM (presumably seizing...but possibly dreaming about being a bunny rabbit in a meadow) and was hopping on all fours in the bed. It was an awesome case, and I couldn't help but wonder strongly whether the true diagnosis was a pediatric case of idiopathic RBD.

The case presenter of this last was from UNC...Dr. Vaughn I believe.

 

[danielmd06]

Update!

The patient I tried this on had complete resolution (per his wife) of his RBD on 10 mg melatonin! He's here for one month follow-up today.

Of course, he's still non-compliant with his CPAP and has an Epworth of 17...but that's a story for another day.

 

[slope]

I just saw a couple of days ago someone with OSA (adequately treated) and RBD. He was prescribed Klonopin 1 mg with modest improvement of his symptoms; then, the prescribing physician, concerned that the pt might get sedated, added Melatonin. The pt took Melatonin only 2 nights, and the bed partner reported significant worsening of his RBD.

 

[neurologist]

I just saw a couple of days ago someone with OSA (adequately treated) and RBD. He was prescribed Klonopin 1 mg with modest improvement of his symptoms; then, the prescribing physician, concerned that the pt might get sedated, added Melatonin. The pt took Melatonin only 2 nights, and the bed partner reported significant worsening of his RBD.

Interesting. I've had a number of people complain of "nightmares" from taking melatonin for insomnia or circadian disorders, so maybe his dream content worsened and he started acting out more . . .

 

[danielmd06]

I just saw a couple of days ago someone with OSA (adequately treated) and RBD. He was prescribed Klonopin 1 mg with modest improvement of his symptoms; then, the prescribing physician, concerned that the pt might get sedated, added Melatonin. The pt took Melatonin only 2 nights, and the bed partner reported significant worsening of his RBD.

I'm curious what you meant. You say that the physician was concerned about sedation and therefore added melatonin to the dosage of clonazepam?

Or do you mean that he switched the Klonopin out for the melatonin and the RBD symptoms returned after the cessation of Klonopin? If this latter, then I understand better, because melatonin is only supposed to work in around half of cases of so...

If the former, it's very curious and I'm partial to neurologist's explanation.

 

[slope]

daniel, it is one of those situations when I stop trying to find a rationale in some people's mind-boggling treatment plans. They actually added Melatonin to the Klonopin...no comments!