Etiopathogenetic treatment options for somnambulism

Abstract

Background. The incidence of somnambulism is about 7% and has a genetic basis for the disease. In childhood, it mostly runs benignly and independently passes by adulthood. However, under the influence of certain factors, recurrences of sleepwalking episodes (or primary events without a childhood history) can be registered in adulthood, and the risk of harm to the patient or others around him is much higher compared to the pediatric variant of the course of the disease. There are several situations in which it is necessary to treat the disease: first, when somnambulism occurs idiopathically and the inducing factor cannot be identified; second, when episodes of somnambulism lead to life-threatening situations (injuries, bruises, going outdoors, driving a car, etc.). In such a dangerous course of somnambulism, treatment is necessary. It can be based on etiology (in the presence of concomitant diseases or the intake of alcohol and drugs) or on pathogenesis. The latter option includes medication and non-medication methods.

Results. The treatment of somnambulism based on etiopathogenetic mechanisms is reviewed.

Conclusion. It is concluded that treatment can be divided into three blocks: etiologic (if possible to identify the factor provoking episodes of somnambulism, such as alcohol intake, medications, obstructive sleep apnea syndrome or upper airway constriction syndrome and restless legs syndrome); pathogenetic – non-medication (hypnosis, anticipatory awakening, sleep hygiene and normalization of emotional state) and medication (most commonly benzodiazepine receptor agonists clonazepam and diazepam in low doses or antiepileptic drugs such as gabapentin and pregabalin).