What treatment works best for restless legs syndrome? Meta-analyses of dopaminergic and non-dopaminergic medications

Hornyak, Magdolna; Scholz, Hanna; Kohnen, Ralf; Bengel, Juergen; Kassubek, Jan; Trenkwalder, Claudia

doi:10.1016/j.smrv.2013.03.004

Cited by 79 publications

(53 citation statements)

References 61 publications

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“…The pathophysiology of RLS remains poorly understood [3]. Two major findings concern the impaired metabolism of intracerebral iron [4] and the therapeutic effect of dopaminergic agonists [5]. One distinguishes an idiopathic form with early-onset and frequent family history from a late-onset secondary form.…”

Section: Introductionmentioning

confidence: 99%

Brainstem Stroke-Related Restless Legs Syndrome: Frequency and Anatomical Considerations

et al. 2014

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Background: Given the discordant results of studies that have reported cases of RLS associated with brainstem stroke and the absence of RLS in large series describing the clinical spectrum of brainstem infarctions, we decided to assess RLS in all patients admitted for brainstem stroke. Methods: All patients who were consecutively referred to the Strasbourg stroke unit for brainstem infarction were prospectively evaluated for RLS. The different parameters analyzed were the topography of the ischemic lesions (magnetic resonance imaging), the different symptoms (sensory, motor, cerebellar, cranial nerves and dysarthria) and the NIH stroke scale. Statistical analyses used the Bayesian paradigm. Results: Thirty patients have been included, and RLS was observed in three patients (10%). Two patients suffered from an exacerbation of symptoms anterior to the stroke, and the other patient a de novo, but transient, RLS. Patients with stroke-induced sensory symptoms have a higher risk to develop brainstem stroke-related RLS as compared to patients without sensory symptoms. Conclusion: The results suggest that RLS should be systematically screened in patients affected with brainstem stroke, especially in the case of stroke-induced sensory symptoms. Clinicians should be aware of this association, especially as efficient treatments are available and allow improving the management of patients affected with stroke. i 2014 S. Karger AG, Basel

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Section: Introductionmentioning

confidence: 99%

Brainstem Stroke-Related Restless Legs Syndrome: Frequency and Anatomical Considerations

et al. 2014

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“…22,28,31,[34][35][36] The current AASM practice parameter recommends treatment with a non-ergotamine dopamine agonist (pramipexole or ropinirole) as a standard, with the use of the calcium channel alpha-2-delta ligand gabapentin enacarbil (and other medications, including opiates) as a guideline. 22 Reviews by other RLS stakeholder groups have led to similar but not identical recommendations; some have reported equivalent high level recommendations for both the non-ergotamine dopamine agonists (including rotigotine) and the three calcium channel alpha-2-delta ligands (gabapentin enacarbil, gabapentin, and pregabalin).…”

Section: Supporting Evidence and Rationalementioning

confidence: 99%

“…35 Current expert consensus guidelines recommend that patients be asked about symptoms of augmentation at every visit 41 or that augmentation be "carefully assessed. 28 Augmentation should be defined based on currently accepted criteria.…”

Section: Supporting Evidence and Rationalementioning

confidence: 99%

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Quality Measures for the Care of Adult Patients with Restless Legs Syndrome

Trotti

Goldstein

Harrod

et al. 2015

Journal of Clinical Sleep Medicine

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The American Academy of Sleep Medicine (AASM) commissioned several Workgroups to develop quality measures for the care of patients with common sleep disorders, including adults with restless legs syndrome (RLS). Using the AASM process for quality measure development, the RLS Workgroup developed three target outcomes for RLS management, including improving the accuracy of diagnosis, reducing symptom severity, and minimizing treatment complications. Seven processes were developed to support these outcomes. To achieve the outcome of improving accuracy of diagnosis, the use of accepted diagnostic criteria and assessment of iron stores are recommended. To realize the outcome of decreasing symptom severity, routine assessment of severity and provision of evidence-based treatment are recommended.To support the outcome of minimizing treatment complications, counseling about potential side effects and assessing for augmentation and impulse control disorders, when indicated, are recommended. Further research is needed to validate optimal practice processes to achieve best outcomes in adult patients with RLS. Citation: Trotti LM, Goldstein CA, Harrod CG, Koo BB, Sharon D, Zak R, Chervin RD. Quality measures for the care of adult patients with restless legs syndrome. J Clin Sleep Med 2015;11(3):293-310.pii: jc-00027-15 http://dx.doi.org/10.5664/jcsm.4550 R estless legs syndrome (RLS), also referred to as WillisEkbom Disease (WED), is one of the most common sleep disorders, affecting between 5% and 10% of the United States population.1,2 RLS can adversely impact quality of life, disrupt sleep, impair daytime function, and impact mood. 1,[3][4][5][6] The delivery of high quality care for RLS depends on correct diagnosis, work-up for known comorbid conditions, delivery of appropriate evidence-based treatment, and follow up for treatment effectiveness and complications. 7 These aspects of RLS care may be subject to substantial practice variation, presenting opportunities for quality improvement.Ensuring quality healthcare is a priority within the American medical system. The promotion of high quality sleep care is central to the mission of the AASM, which seeks to "improve sleep health and promote high quality patient-centered care through advocacy, education, strategic research, and practice standards."8 To this end, the AASM commissioned Workgroups to develop quality care measures aimed at optimizing care for patients suffering from the most common sleep-related disorders, including adults with RLS. 9 These quality care measures focus on both outcomes, that is, what happens to a patient as a result of the care received, and processes, or the steps taken by a healthcare provider in the care of an individual patient. Both outcomes and processes are important in the care of the patient. Outcomes are often more directly relevant to the patient, whereas processes tend to be less infl uenced by factors outside an individual provider's control. All RLS outcomes and processes detailed in this report were developed by the RLS Quality ...

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“…There are currently over 30 randomized, placebo-controlled studies and several published evidence-based reviews and meta-analyses of dopaminergic treatments for RLS [34,[69][70][71][72][73][74]. Overall, the direct dopamine agonists have been found to be effective in shortand longer-duration placebo-controlled studies for the treatment of RLS and PLMS.…”

Section: Dopamine Agonists For Rlsmentioning

confidence: 99%

Treatment of Restless Legs Syndrome

Comella¹

2014

Neurotherapeutics

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Restless legs syndrome (RLS) is a common disorder diagnosed by the clinical characteristics of restlessness in the legs associated often with abnormal sensations that start at rest and are improved by activity, occurring with a diurnal pattern of worsened symptoms at night and improvement in the morning. RLS is the cause of impaired quality of life in those more severely afflicted. Treatment of RLS has undergone considerable change over the last few years. Several classes of medications have demonstrated efficacy, including the dopaminergic agents and the alpha-2-delta ligands. Levodopa was the first dopaminergic agent found to be successful. However, chronic use of levodopa is frequently associated with augmentation that is defined as an earlier occurrence of symptoms frequently associated with worsening severity and sometimes spread to other body areas. The direct dopamine agonists, including ropinirole, pramipexole, and rotigotine patch, are also effective, although side effects, including daytime sleepiness, impulse control disorders, and augmentation, may limit usefulness. The alpha-2-delta ligands, including gabapentin, gabapentin enacarbil, and pregabalin, are effective for RLS without known occurrence of augmentation or impulse control disorders, although sedation and dizziness can occur. Other agents, including the opioids and clonazepam do not have sufficient evidence to recommend them as treatment for RLS, although in an individual patient, they may provide benefit.

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What treatment works best for restless legs syndrome? Meta-analyses of dopaminergic and non-dopaminergic medications

Cited by 79 publications

References 61 publications

Brainstem Stroke-Related Restless Legs Syndrome: Frequency and Anatomical Considerations

Brainstem Stroke-Related Restless Legs Syndrome: Frequency and Anatomical Considerations

Quality Measures for the Care of Adult Patients with Restless Legs Syndrome

Treatment of Restless Legs Syndrome

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