PD – REM Sleep Behaviour Disorder Treatment — SCE Neurology MCQ

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ModerateSleep DisordersPD – REM Sleep Behaviour Disorder TreatmentSCE Neurology

A 70-year-old woman with a 10-year history of PD develops REM sleep behaviour disorder. She shouts and acts out vivid dreams, occasionally hitting her husband. Her PD medications have been optimised. Per NICE NG71, what is the recommended pharmacological treatment for RBD?

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Correct answer: C — Melatonin

NICE NG71 recommends considering clonazepam or melatonin for REM sleep behaviour disorder in PD. Melatonin is increasingly preferred as first-line due to its favourable side-effect profile (no respiratory depression, no cognitive impairment, low fall risk) compared to clonazepam, particularly in elderly patients with PD who are vulnerable to the sedating and cognitive effects of benzodiazepines. A: Melatonin is the preferred first-line option. C: Clonazepam is effective but has more side effects in the elderly. B: Zolpidem is for insomnia, not RBD. D: Quetiapine is for psychosis. E: Gabapentin has no role in RBD.

Reference: NICE NG71 Parkinson's Disease (2017)