A controlled study of additional sr-
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            -dopa in
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            -dopa–responsive restless legs syndrome with late-night symptoms

Collado-Seidel, V.; Kazenwadel, J.; Wetter, Thomas C.; Kohnen, Ralf; Winkelmann, Juliane; Selzer, Roland; Oertel, Wolfgang H.; Trenkwalder, Claudia

doi:10.1212/wnl.52.2.285

Cited by 140 publications

(82 citation statements)

References 18 publications

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“…This study showed that the addition of SR levodopa resulted in improvement in RLS symptoms, reduced PLMS, increased time in bed, and improved subjective quality of sleep. However, during the 8-week study period, 17 % of patients noted that their RLS symptoms were now occurring in the afternoon [62]. The 1-year, open-label extension of this study showed that 60 % treated with either IR or SR levodopa developed daytime symptoms [67].…”

Section: Dopamine Agonists For Rlsmentioning

confidence: 69%

“…However, this is not typically used for diagnosis, with the cardinal features being the major subjective criteria. Following these initial reports, long-term follow-up of patients showed recurrence of RLS symptoms in the morning (rebound) and the augmentation [61][62][63]. Augmentation refers to the worsening of RLS symptom severity from pretreatment levels following an initial benefit from the drug for most days of the week associated with an earlier onset of symptoms by at least 2-4 h, often associated with a shorter latency to RLS symptoms at rest, spread to other body areas, and increased intensity of symptoms [64].…”

Section: Dopamine Agonists For Rlsmentioning

confidence: 85%

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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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Section: Dopamine Agonists For Rlsmentioning

confidence: 69%

Section: Dopamine Agonists For Rlsmentioning

confidence: 85%

Treatment of Restless Legs Syndrome

Comella¹

2014

Neurotherapeutics

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“…[16][17][18] Restless legs syndrome symptoms may result from a decrease in dopaminergic modulation of intracortical excitability with reduced supraspinal inhibition and increased spinal excitability. [19][20][21] Iron deficiency or iron transport to the central nervous system play a central role in RLS. Iron is a cofactor for tyrosine hydroxylase, which has a role in dopamine synthesis at the rate-limiting step.…”

Section: Discussionmentioning

confidence: 99%

“…Iron is a cofactor for tyrosine hydroxylase, which has a role in dopamine synthesis at the rate-limiting step. [20][21] Even ferritin, or transferrin saturation index, are normal, cerebrospinal fluid ferritin levels may show CNS iron deficiency syndrome. Restless legs syndrome often persists with hemodialysis, but it improves after transplant, which may be associated with the normal calcium (Ca) and phosphorus (P) metabolism.…”

Section: Discussionmentioning

confidence: 99%

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Kahvecioğlu

Yıldız²,

Büyükkoyuncu³

et al. 2016

Exp Clin Transplant

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Objectives: Restless legs syndrome is a disorder in which patients have irresistible urge to move legs during rest. Restless legs syndrome seems to be common in end-stage renal disease. After a successful renal transplant, symptoms ameliorate with renal function improvement and restless legs syndrome is seen less in this population. Here, we aimed to investigate restless legs syndrome frequency and associated factors in renal transplant patients. Materials and Methods:In a cross-sectional study with 193 patients (116 hemodialysis patients, 45 transplant patients, and 32 controls), the presence of restless legs syndrome was assessed using the Restless Legs Syndrome Questionnaire. Medical history, demographic, and laboratory data were collected from the patients' medical records. Patients were questioned about the presence of restless legs syndrome using the Restless Legs Syndrome Questionnaire. Patients were evaluated with Beck Depression Scale for depression and Pittsburgh tests for sleep disturbances. Results: While the rate of restless legs syndrome was similar between transplants and controls, it was significantly greater in hemodialysis patients. Hemodialysis patients and controls had similar depression scores that were higher compared with transplant patients. Pittsburgh score was similar in transplant patients and controls and significantly increased in the hemodialysis patients. The rate of insomnia was significantly higher in the hemodialysis patients compared with the other 2 groups. Logistic regression analysis revealed independent correlates of restless legs syndrome as insomnia, Beck depression score, and being on hemodialysis. Linear regression analysis showed that independent correlates of higher Pittsburgh score were higher depression score, higher age, and presence of restless legs syndrome. Conclusions: The prevalence of restless legs syndrome is significantly lower in transplant patients than it is in patients on maintenance dialysis. In renal transplant patients, restless legs syndrome frequency was found to be lower because of improved renal functions (normalization of uremia), psychological symptoms, and sleep disturbances.

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“…A combination therapy of standard and SR-L-Dopa was found more ecient in maintaining sleep and improve symptoms. 81,82 This has also been found a safe and eective therapy for patients in endstage renal disease with RLS. 18,34,83 Various approaches to the treatment of idiopathic and uremic RLS are reviewed by Trenkwalder et al 84 and the practical management of therapy outlined.…”

Section: Restless Legs Syndrome Fe Glasauermentioning

confidence: 97%

Restless Legs Syndrome

Glasauer

2001

Spinal Cord

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Restless Legs Syndrome (RLS) is a well-de®ned symptom complex and is frequently associated with sleep disturbance and a recognized family history. It occurs either as idiopathic RLS or in association with many medical, neurological or vascular disorders. The neurological examination and routine investigations in idiopathic RLS are normal. Polysomnography supports the diagnosis of RLS by documenting the associated sleep disturbances and periodic limb movements in sleep (PLMS). Although MRI studies disclose no intracerebral lesions, recent Positron Emission Tomography (PET) and single photon emission computed tomography (SPECT) studies point to some involvement of the basal and red nuclei and the cerebellum. No de®nitive etiology is known for this condition, but several pathophysiological mechanisms have been proposed. There is supportive evidence that RLS is a Central Nervous System (CNS) dysfunction, suggesting widespread involvement of the descending dopaminergic (DA) pathways, possibly originating in the diencephalon or upper brainstem. This is corroborated by the successful treatment of RLS with DA agents, sedatives, and neurotransmitters. However, RLS can also occur with spinal disorders and spinal cord lesions implying the existence of a spinal generator. The incidence of RLS in pregnancy is well known and its association with vascular disorders supports another mechanism in some patients. The primary treatment of RLS is largely symptomatic and quite eective with DA agents, DA agonists, opioids and other neurotransmitters. The treatment of RLS associated with various diseases is aimed at the correction of the underlying pathological or de®ciency states. Antidepressant medications frequently precipitate or worsen the condition of RLS. Spinal Cord (2001) 39, 125 ± 133

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A controlled study of additional sr- l -dopa in l -dopa–responsive restless legs syndrome with late-night symptoms

Abstract: A combination therapy of rr-L-dopa and sr-L-dopa is better than monotherapy with rr-L-dopa in reducing the frequency of PLM and problems maintaining sleep, even in patients who are severely affected.

Cited by 140 publications

References 18 publications

Treatment of Restless Legs Syndrome

Treatment of Restless Legs Syndrome

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Restless Legs Syndrome

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