Efficacy of yokukansan compared with clonazepam for rapid eye movement sleep behaviour disorder: a preliminary retrospective study
- PMID: 32478914
- DOI: 10.1111/psyg.12563
Efficacy of yokukansan compared with clonazepam for rapid eye movement sleep behaviour disorder: a preliminary retrospective study
Abstract
Aim: Rapid eye movement sleep behaviour disorder (RBD) is characterized by abnormal behaviours accordant with nightmares during rapid eye movement sleep and is considered a prodromal marker of dementia with Lewy body. Most common in the elderly population, RBD is generally treated with clonazepam (CZP), a long-term acting benzodiazepine antiepileptic. As such, alternative drugs for RBD are urgently needed to minimize the adverse effects peculiar to benzodiazepines. The efficacy of yokukansan (YKS), a traditional Japanese herbal medicine, on RBD was initially reported by Shinno et al. in 2008. However, no study has compared YKS with CZP. Therefore, this study aimed to clarify the possibility of using YKS as an alternative to CZP.
Methods: This was a retrospective cohort study conducted at Jikei University Affiliated Hospital. The subjects were selected from 36 outpatients who had been diagnosed with RBD based on the International Classification of Sleep Disorders, third edition. Of the 23 who met the inclusion criteria but not the exclusion criteria, 11 were treated with YKS monotherapy, and 12 were treated with CZP monotherapy. The primary outcome was the total score on the Japanese version of the Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ-JP), and the secondary outcomes were the scores from the eight-item Short-Form Health Survey and factors 1 and 2 of the RBDQ-JP.
Results: The mean total RBDQ-JP score significantly improved from 52.5 to 21.7 (P = 0.002) after treatment with YKS (mean dosage: 3.0 g/day), which was similar to the change after CZP treatment (from 43.8 to 21.3). On RBDQ-JP factor 1 (dream content), the mean score on five of six items significantly improved after treatment with YKS. There was no significant change in Short-Form Health Survey scores after treatment with either drug. Potassium concentrations were within the normal range in patients treated with YKS.
Conclusions: The present results suggest that a small amount of YKS may be an alternative to CZP for RBD, without remarkable adverse events. Further study is needed to prospectively clarify the efficacy and safety of YKS in more detail.
Keywords: Kampo medicine; clonazepam; nightmare; rapid eye movement sleep behaviour disorder; yokukansan.
© 2020 Japanese Psychogeriatric Society.
Similar articles
-
Effect of Yokukansan for the Treatment of Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Retrospective Analysis of Consecutive Patients.J Clin Sleep Med. 2019 Aug 15;15(8):1173-1178. doi: 10.5664/jcsm.7816. J Clin Sleep Med. 2019. PMID: 31482840 Free PMC article.
-
A prospective, naturalistic follow-up study of treatment outcomes with clonazepam in rapid eye movement sleep behavior disorder.Sleep Med. 2016 May;21:114-20. doi: 10.1016/j.sleep.2015.12.020. Epub 2016 Feb 16. Sleep Med. 2016. PMID: 27448481
-
Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy--a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group.Sleep Med. 2013 Aug;14(8):795-806. doi: 10.1016/j.sleep.2013.02.016. Epub 2013 Jul 22. Sleep Med. 2013. PMID: 23886593 Free PMC article.
-
Effects of long-term use of clonazepam on nonrapid eye movement sleep patterns in rapid eye movement sleep behavior disorder.Sleep Med. 2013 May;14(5):399-406. doi: 10.1016/j.sleep.2013.01.007. Epub 2013 Mar 9. Sleep Med. 2013. PMID: 23490738
-
Rapid eye movement sleep behavior disorder.Ann Pharmacother. 2007 Nov;41(11):1833-41. doi: 10.1345/aph.1H587. Epub 2007 Oct 9. Ann Pharmacother. 2007. PMID: 17925503 Review.
Cited by
-
REM sleep behavior disorder: update on diagnosis and management.Arq Neuropsiquiatr. 2023 Dec;81(12):1179-1194. doi: 10.1055/s-0043-1777111. Epub 2023 Dec 29. Arq Neuropsiquiatr. 2023. PMID: 38157884 Free PMC article.
-
Management of REM sleep behavior disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.J Clin Sleep Med. 2023 Apr 1;19(4):769-810. doi: 10.5664/jcsm.10426. J Clin Sleep Med. 2023. PMID: 36515150 Free PMC article.
-
Current Treatment Options for REM Sleep Behaviour Disorder.J Pers Med. 2021 Nov 14;11(11):1204. doi: 10.3390/jpm11111204. J Pers Med. 2021. PMID: 34834556 Free PMC article. Review.
-
Cellular Effects of Rhynchophylline and Relevance to Sleep Regulation.Clocks Sleep. 2021 Jun 9;3(2):312-341. doi: 10.3390/clockssleep3020020. Clocks Sleep. 2021. PMID: 34207633 Free PMC article. Review.
-
Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep.Nutrients. 2021 Feb 6;13(2):530. doi: 10.3390/nu13020530. Nutrients. 2021. PMID: 33561990 Free PMC article.
References
REFERENCES
-
- Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in sleep. Sleep 2002; 25: 120-138.
-
- American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd edn. Darien, IL: American Academy of Sleep Medicine, 2014.
-
- Boeve BF, Saper CB. REM sleep behavior disorder: a possible early marker for synucleinopathies. Neurology 2006; 66: 796-797.
-
- Mariotti P, Quaranta D, Di Giacopo R et al. Rapid eye movement sleep behavior disorder: a window on the emotional world of Parkinson disease. Sleep 2015; 38: 287-294.
-
- Anderson KN, Shneerson JM. Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam. J Clin Sleep Med 2009; 5: 235-239.
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Research Materials
Miscellaneous