Use of Melatonin for Sleep Disorders in Children with Cerebral Palsy

Cerebral Palsy (CP) is a group of disorders of movement and posture caused by a non-progressive interference, lesion or abnormality of the immature brain which is often accompanied by impairment of sensation, cognition and communication and affecting more than 2 per 1000 live-born children [1]. Sleep disorders are more frequent in CP than in typically developing children with a prevalence varying from 19 to 63% according to different studies. Different feature such as motor or cognitive impairment, behavioral problems or epilepsy are important risk factors for the development of sleep disorders. [2-4]. No specific studies on sleep intervention for children with CP are reported in literature [2] even if a good “sleep hygiene”, parentbased education and behavioural interventions [2], should be adopted before beginning a specific therapy. Melatonin (N-acetyl-5methoxytryptamine), a tryptophan-derived molecule, is a chronobiotic drug produced by the pineal gland essential for the regulation of the sleep-wake cycle. During the day, the synthesis of melatonin is limited, being the concentrations peaking at approximately midnight, due to the liberation of norepinephrine through the beta-adrenergic receptors in the pinealocytes [2,5]. Melatonin has been mainly used in circadian rhythm disorders in adults such as sleep disturbances, jet lag, sleepwake cycle disturbances in blind people and shift workers. Recently it has been proposed in children with sleep disturbances confirming its role in improving sleep [2,5]. It is considered safe and well tolerated with a long term effectiveness in improving sleep [2,5].