Levodopa for idiopathic restless legs syndrome: Evidence‐based review

Abstract

Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. The prevalence of RLS is estimated at 2.7 to 5% of adults and it is more common in women. The treatment of RLS with levodopa has been reported thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of levodopa for RLS. Systematic review of randomized or quasi-randomized, double blind trials on levodopa. Relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Nine eligible clinical trials were included. The subjective analyses of these studies showed contradictory results, although the objective analyses showed that treatment group had a statistically significant improvement of periodic leg movement (PLM) index, favoring the treatment group. The most commonly adverse event seen was gastrointestinal symptoms. The short-term treatment with levodopa was demonstrated effective and safety for PLM, but there was only few trials assessing long-term treatment and the augmentation phenomenon in RLS. Further long-term randomized controlled trials using standard follow-up measurements as the International RLS Study Group Rating Scale are necessary.

Appropriate Use of Dopamine Agonists and Levodopa in Restless Legs Syndrome in an Ambulatory Care Setting

“…22, 23 The starting dose of levodopa/carbidopa that had been used in various studies was 100 mg/25 mg, with the maintenance dose ranging from 100 mg/25 mg to 200 mg/50 mg approximately one hour before bedtime. 24 All patients on levodopa were instructed to take levodopa daily rather than intermittently. Such daily dosing has been associated with augmentation characterized by worsening of RLS symptoms and earlier onset with chronic use.…”

Treatment of Restless Legs Syndrome

“…This opened the door for a new era of therapeutic approaches to RLS. Subsequently, there were 9 controlled studies evaluating the efficacy of levodopa at doses ranging from 100 to 500 mg, but only in a limited number of patients (up to a maximum of 28) for a short period of time (up to 6 weeks) [58]. Although the outcome measures and study designs varied considerably among these studies and the results were mixed, many of these early studies found that levodopa provided significant subjective and objective benefit with few side effects.…”

Terapia Cognitivo Comportamental para Pacientes Portadores da Síndrome das Pernas Inquietas

“…Este desconforto físico e a necessidade de movimentação dos membros causam insônia 14 , despertares noturnos 15 , dificuldade em manter o sono, com consequente diminuição de sua eficiência e qualidade 16 , promovendo impacto nas atividades diurnas e na qualidade de vida do indivíduo acometido 17,18 . Em alguns casos o paciente deixa de ter uma vida social adequada, por exemplo, fica impossibilitado de fazer viagens longas, permanecer em cinema, teatro, ou demais condições que demandem repouso 1,19,20 .…”