Long-term effects of pergolide in the treatment of restless legs syndrome

Stiasny, Karin; Wetter, Thomas C.; Winkelmann, Juliane; Brandenburg, U.; Penzel, Thomas; Rubin, M.; Hundemer, Hans-Peter; Oertel, Wolfgang H.; Trenkwalder, Claudia

doi:10.1212/wnl.56.10.1399

Cited by 92 publications

(45 citation statements)

References 10 publications

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“…Another major finding of this study is that a single evening dose of pramipexole alleviated daytime symptoms in all patients who had previously developed augmentation under levodopa and thus pramipexole is an interesting alternative in this subgroup of patients. Pramipexole seems to have several advantages: (a) since a low dose of pramipexole is already effective, there is no need for the long titration period usually necessary when patients receive longer-acting dopamine agonists such as pergolide [22] or cabergoline [7]; (b) dopaminergic side-effects seem to be rare, and in the presented study it was not necessary to administer pramipexole in combination with domperidone (domperidone is usually prescribed in pergolide-treated patients to limit peripheral dopaminergic side-effects [22,23]), and (c) the possible antidepressive effect of pramipexole as seen in patients with major depression [24]. Depression seems to be more frequent in RLS [25] and it has already been demonstrated that RLS patients improve on the Zung Self-Rating Depression Scale [26] when taking pramipexole [12].…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Pramipexole in the Management of Restless Legs Syndrome

Stiasny‐Kolster

Oertel²

2004

Neuropsychobiology

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Dopaminergic agents are considered the treatment of choice for restless legs syndrome (RLS); levodopa is the only substance licensed for this disorder in some European countries. However, in a substantial proportion of patients symptoms are not adequately controlled for a whole night due to the short half-life of levodopa or because symptom augmentation may develop. To further investigate the impact of pramipexole on the management of RLS we performed a short-term open label trial with pramipexole in 17 patients who were being insufficiently treated with levodopa or for whom pramipexole was primarily being considered because of the severity of the RLS symptoms. A single dose of 0.125–0.75 mg pramipexole (mean 0.3 ± 0.2 mg) in the evening resulted in a significant improvement of subjective RLS symptoms as rated by the International RLS Study Group Severity Scale (IRLS scores: 29.8 ± 4.7 baseline vs. 7.3 ± 5.9 endpoint; p = 0.0001). Polysomnographic recordings showed a significant improvement of the periodic leg movements (PLM) index, PLM sleep arousal index, sleep-onset latency, total sleep time and sleep efficiency. All patients who had developed a worsening of RLS symptoms under levodopa recovered from daytime symptoms after their medication was switched to pramipexole. Since pramipexole was well tolerated, an ideal dosage to control RLS symptoms could be reached rapidly. Pramipexole has proven a suitable alternative in patients with moderate to severe RLS, particularly when their therapy has to be switched to a dopamine agonist.

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Section: Discussionmentioning

confidence: 99%

Low-Dose Pramipexole in the Management of Restless Legs Syndrome

Stiasny‐Kolster

Oertel²

2004

Neuropsychobiology

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“…The most common prescriptions were for benzodiazepines, presumably as these agents alleviate the secondary sleeprelated symptoms common among RLS sufferers. That very few physicians were prescribing dopamine agonists and L-dopa is perhaps not surprising as the study period predates the publication of many clinical trials demonstrating the efficacy of these drugs [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of restless legs syndrome as diagnosed in UK primary care

2004

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Background and purpose: Restless legs syndrome (RLS) is a sensorimotor disorder with a general-population prevalence of 5-10%. Although, data on the prevalence of clinically diagnosed RLS are limited, and there are none regarding incidence, a shortfall compared with general-population values is likely, as not all patients are driven to consult. There may also be poor awareness of the condition among primary care physicians (PCPs).Patients and methods: The General Practice Research Database was used to gather prevalence and incidence data from UK PCPs and to investigate PCP awareness over the period 1994-1998. A total of 1,561,692 persons were covered by the database on January 1, 1999.Results: A diagnosis of RLS was registered in 3877 patients, giving a prevalence of 0.25%. Incidence values were also low (41.0 per 100,000 person-years), increased with age and were higher in women than in men. Although, at least one RLS diagnosis was made in 94% of medium-to-large practices, sufferers were more likely than age/sex-matched controls to be diagnosed with conditions commonly confused with RLS in 2 years before receiving their RLS diagnosis. Furthermore, at the time of diagnosis, many sufferers were prescribed medications not effective in RLS (principally, oxerutins and quinine).Conclusion: These data are largely consistent with a lack of awareness of RLS among PCPs in the UK in the period studied. q

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“…It has demonstrated good efficacy in several small clinical trials. [21][22][23] However, ergot-derived dopamine agonists such as pergolide carry the potential risk of fibrotic complications and may be associated with valvular heart disease. 24 As the dopamine agonists ropinirole and pramipexole are not ergot-derived, they are not typically associated with the risk of structurally related fibrotic complications.…”

mentioning

confidence: 99%

Ropinirole is effective in the treatment of restless legs syndrome. TREAT RLS 2: A 12‐week, double‐blind, randomized, parallel‐group, placebo‐controlled study

et al. 2004

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Restless legs syndrome (RLS) is a neurological condition with significant impact on sleep and quality of life (QoL). This double-blind, randomized, 12-week, multinational study compared the efficacy and safety of ropinirole and placebo in RLS. In total, 267 outpatients with moderate-to-severe RLS were randomly assigned to ropinirole (0.25-4.0 mg/day) or placebo, 1 to 3 hours before bedtime. The primary endpoint was the change in International Restless Legs Scale (IRLS) score at week 12. Key secondary endpoints were the percentage of patients showing significant improvement on the Clinical Global Impression-Improvement (CGI-I) scale at week 12 and changes in IRLS and CGI-I scale scores at week 1. Other measures included the Medical Outcomes Study sleep scale and Restless Legs Syndrome Quality of Life questionnaire. Improvements were significantly greater for ropinirole than placebo for change in IRLS score at week 12 (-11.2 [SE 0.76] vs. -8.7 [0.75], respectively; adjusted treatment difference -2.5 [95% confidence interval [CI], -4.6, -0.4], P = 0.0197); all key secondary endpoints; sleep and QoL parameters. Adverse events were typical for dopamine agonists; disease augmentation, although not directly assessed, was not reported during treatment. Ropinirole improves symptoms, associated sleep disturbance, and QoL of RLS patients and is generally well tolerated.

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Long-term effects of pergolide in the treatment of restless legs syndrome

Cited by 92 publications

References 10 publications

Low-Dose Pramipexole in the Management of Restless Legs Syndrome

Low-Dose Pramipexole in the Management of Restless Legs Syndrome

Epidemiology of restless legs syndrome as diagnosed in UK primary care

Ropinirole is effective in the treatment of restless legs syndrome. TREAT RLS 2: A 12‐week, double‐blind, randomized, parallel‐group, placebo‐controlled study

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