Restless legs syndrome and periodic leg movements of sleep.

Background and purpose

It is not clear which is preferred between iron supplement and a dopamine agonist in the treatment of restless legs syndrome (RLS) with iron deficiency. The efficacies of oral iron supplementation and pramipexole for treatment of RLS with low-normal serum ferritin (15–50 ng/ml) were compared.



Methods

Thirty RLS patients who took either oral iron or pramipexole for 12 weeks and were followed at 2, 4, 8 and 12 weeks after treatment commencement were enrolled. Severities of RLS symptoms were assessed using the international RLS study group rating scale for severity (IRLS) at every visit. Treatment response was defined as a decrease in IRLS score of at least 50% from baseline.



Results

The 30 subjects were assigned equally to an iron or pramipexole group. At baseline, IRLS scores and serum ferritin levels were similar between these two groups. After 12 weeks, IRLS scores were lower than those at baseline in both groups (iron −9.1 ± 7.07, P < 0.001; pramipexole −8.7 ± 8.31, P = 0.001) and similar between the two groups. Changes in IRLS scores from baseline were similar between the two groups at each visit. The response rates of the groups were identical at 46.7%.



Conclusions

Pramipexole was not different from oral iron in terms of efficacy and improvement speed in RLS patients with a low-normal serum ferritin, but response rate of either oral iron or pramipexole alone was moderate. Some proportion of RLS patients with iron deficiency might benefit from combined use of oral iron and dopamine agonists.

Comparison of the efficacies of oral iron and pramipexole for the treatment of restless legs syndrome patients with low serum ferritin.

Restless legs syndrome (RLS) is characterized by a compelling, often insatiable, need to move the legs, accompanied by unpleasant sensations located mainly in the ankles and calves. Because symptoms are brought on by inactivity, distress intrudes upon everyday, sedentary activities such as plane travel, car rides, and attending school, meetings, or the theatre. Symptoms show a diurnal preference for the evening and night, so disruption of sleep onset or maintenance is particularly common. RLS is associated with both lower ratings of quality of life and higher rates of cardiovascular disease. Four common genetic loci associating to RLS have recently been identified, but the molecular pathways by which they increase risk for RLS have yet to be determined. Both sensory (RLS) and motor (periodic limb movements of sleep) symptoms are responsive to dopaminergic medications, yet clear delineation of dopaminergic pathology has not emerged. Brain iron is reduced in many, but not all, patients with RLS. First-line treatment for RLS includes agents acting at D(2) and D(3) dopamine receptors.

Restless legs syndrome.

The emergence of new effective therapies for idiopathic restless legs syndrome (iRLS) or Willis–Ekbom disease (WED) during the last 15 years resulted in an exponential increase of reports regarding this syndrome and, especially, treatment options. In this review, we summarise the main findings related to neuropharmacological aspects and non-pharmacological therapies of idiopathic RLS (iRLS). As was previously reported in several guidelines, dopamine agonists (fundamentally nonergotic derivatives), gabapentin and pregabalin should be considered as first-line therapies, as well as opiates as an alternative drug group. Preliminary results suggest that several non-pharmacological therapies should be promising as alternatives or adjuvants to drug treatments.

/pdf/treatment-options-for-idiopathic-restless-legs-syndrome-3uq8is6lxj.pdf

Treatment Options for Idiopathic Restless Legs Syndrome

Leczenie choroby Parkinsona (PD, Parkinson’s disease ) jako jednej z niewielu chorob neurodegeneracyjnych, chociaz objawowe, to przez wiele lat moze byc skuteczne. Oprocz lewodopy, slusznie nadal uwazanej za „zloty standard” w leczeniu PD, dysponujemy dziś innymi lekami. Wśrod nich pod wzgledem sily dzialania agoniści dopaminy są umieszczani na drugim miejscu. Mimo najwiekszej skuteczności, stosowanie lewodopy w PD wiąze sie z ryzykiem rozwoju fluktuacji i dyskinez. Agoniści dopaminy, a szczegolnie wprowadzone w ostatnich latach ich postacie o przedluzonym uwalnianiu, są skuteczną alternatywą dla lewodopy we wczesnej fazie leczenia, szczegolnie u mlodszych chorych, a w fazie rozwinietej choroby mogą byc stosowane w terapii dodanej do lewodopy, ograniczając wymienione powiklania. Jest to takze grupa lekow o udowodnionej skuteczności w terapii zespolu niespokojnych nog — w jego postaci codziennej jako tak zwana pierwsza linia leczenia. W niniejszym artykule omowiono zasady stosowania tych lekow z wieloma praktycznymi uwagami i w odniesieniu do rekomendacji towarzystw naukowych, wynikających z klasyfikacji interwencji medycznych opartej na dowodach.

/pdf/agonisci-dopaminy-w-leczeniu-choroby-parkinsona-i-zespolu-14apa7mjm7.pdf

Agoniści dopaminy w leczeniu choroby Parkinsona i zespołu niespokojnych nóg

Iron-deficient states can be associated with restless legs syndrome (RLS), and serum ferritin is recommended in screening for iron deficiency in RLS.1 2 Dopamine agonists are first-line treatment for idiopathic RLS, but it is not known if patients’ serum ferritin concentrations influence their responses to these drugs. We wanted to determine if patients with idiopathic RLS with lower serum ferritin (⩽50 μg/l) obtain similar benefit from ropinirole to those with “normal” (>50 μg/l) serum ferritin.2 A post hoc analysis of combined data from two pivotal RLS clinical trials revealed equal benefits of ropinirole over placebo in patients with serum ferritin above or below 50 μg/l.

Data were pooled from two similarly designed, 12-week, randomised, double-blind, placebo-controlled studies of ropinirole in idiopathic RLS: TREAT RLS 1 and TREAT RLS 2.3 4 Serum ferritin concentrations were obtained at baseline in all patients entering both clinical trials. Subject inclusion and exclusion criteria have been described previously.3 4

Ropinirole 0.25–4.0 mg/day, or placebo, was titrated as needed and tolerated, and taken once a day 1–3 h before bedtime. Patient improvement at week 12 on the International Restless Legs Scale (IRLS) was the primary end point, and the proportion of patients responding to treatment on the Clinical Global Impression – Improvement (CGI-I) …

https://jnnp.bmj.com/content/jnnp/79/8/964.full.pdf

Response to ropinirole in restless legs syndrome is independent of baseline serum ferritin

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Response to ropinirole in restless legs syndrome is independent of baseline serum ferritin