Medical Care
The neurologist may consult a sleep specialist for the proper diagnosis and treatment of rapid eye movement sleep behavior disorder (RBD). RBD is treated symptomatically with various medications. However, the response varies in individual cases; therefore, all available medications should be tried before considering the patient's RBD as intractable.
Clonazepam is highly effective in almost 90% of patients with RBD. [4, 28, 33] It demonstrates a complete benefit in 79% of patients with the disorder and a partial benefit in 11% of patients. There is little evidence of tolerance or abuse of this drug.
Symptoms relapse promptly on discontinuation of medications in almost all patients; therefore, pharmacologic treatment should be continued indefinitely.
An important aspect of management of patients with RBD is environmental safety. Potentially dangerous objects should be removed from the bedroom, and the mattress should be placed on the floor or a cushion should be placed around the bed.
Long-Term Monitoring
Because RBD has strong relationships with many neurodegenerative disorders, such as Parkinson disease, multiple system atrophy, and dementia, the neurologist always should explore the possibility of RBD in these conditions.
RBD symptoms may be the first manifestations of these disorders and may precede the onset of other typical symptoms and signs by several years. Therefore, careful follow-up is needed to assess the risk of neurodegenerative disorder development, for patient counseling, and to plan for potential neuroprotective trials. [4, 11, 13, 14, 34]
