Curr Treat Options Neurol (2018) 20:26
Sleep Disorders (A Iranzo, Section Editor)
Strategies in the Parasomnias
Raffaele Manni, MD
Gianpaolo Toscano, MD
Michele Terzaghi, MD
Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Via Mondino,
27100, Pavia, Italy
* Springer Science+Business Media, LLC, part of Springer Nature 2018
This article is part of the Topical Collection on Sleep Disorders
Keywords Disorders of arousals (DOA)
Purpose of review The purpose of this review was to discuss the currently available
pharmacologic and non-pharmacologic treatment options for parasomnias.
Recent findings Recent pathophysiological findings about sleep structure in parasomnias
helped understanding several drug mechanisms of action. Serotoninergic theory accounts
for the effect of serotoninergic drugs. Study about spectral analysis of sleep showed the
effect of clonazepam on spectral bands. Cannabinoids proved to be effective in some of
parasomnias, as in many other neurological disorders.
Summary A series of therapeutic strategies were analyzed and compared. Benzodiaze-
pines, antidepressant drugs, and
-5-hydroxytryptophan may be beneficial in DOA. SSRI
and topiramate are effective in SRED. RBD responds to clonazepam, melatonin, and to a
lesser extent to dopaminergic and anticholinergic agents. Prazosin and cannabinoids are
effective in nightmare disorder. Sleep paralysis may respond to antidepressant agents.
Tricyclic antidepressant may be effective in sleep-related hallucinations and exploding
head syndrome. Sleep enuresis may be successfully treated with desmopressin, anticho-
linergic drugs, and imipramine.
Parasomnias are disorders characterized by complex
motor or behavioral events that occur during entry into
sleep, within sleep, or during arousal from sleep .
On the basis of the sleep stage the parasomnias arise
from, they are classified as follows: NREM-related
parasomnias, encompassing disorders of arousals