New Paradigm in the Management of REM Sleep Behavior Disorder

Purpose of Review Rapid eye movement (REM) behavior disorder (RBD) is a complex parasomnia, with growing evidence showing that it represents a prodromal marker for the development of alpha-synuclein neurodegenerative disease. The treatment of RBD previously lacked strong evidence until now. In this paper, we aim to review the current and newly emerging options for the treatment of RBD. Recent Findings The best current evidence in the pharmacologic therapies for RBD is based on small clinical trials and case studies. Clonazepam and melatonin remain the initial standard of treatment and are used as an off-label for RBD. Additional pharmacologic agents have shown potential promise for controlling RBD symptoms, but more research is needed. Currently, large international initiatives such as the IRBDSG, the NAPS consortium, and the PPMI 2.0 are actually recruiting RBD patients into registries to better understand the pathophysiology of RBD, potential biomarkers that indicate phenoconversion to alpha-synuclein states, and to promote further research in neuroprotective trials for disease prevention. Summary The current literature highlights the exciting opportunities to conduct appropriately designed, large-scale, randomized, controlled trials to advance the management of RBD.