Dopamine agonists for restless legs syndrome. - PubMed - NCBI
ثبت نشده
چکیده
According to clinical guidelines, dopamine agonists are the first-line treatment of restless legs syndrome (RLS). To evaluate efficacy and safety of dopamine agonists for RLS. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE, EMBASE, PsycINFO and CINAHL, from January 1985 to December 2008, plus reference lists of articles. We contacted pharmaceutical companies. We included double-blind randomised controlled trials (RCTs) of dopamine agonist treatment versus placebo or other treatment for a period of at least seven days in patients with RLS (≥ 18 years). Outcomes included the International RLS Severity Rating Scale (IRLS), Clinical Global Impressions (CGI-I), polysomnography and self rated sleep quality, quality of life, daytime functioning, and safety parameters. Two reviewers extracted data separately; assessed risk of bias; and contacted pharmaceutical companies and authors for additional information. We collected dropout rates due to adverse events and experience of adverse events. We included 35 placebo controlled and three active controlled RCTs (N = 7365). The mean reduction on the IRLS was -5.7 points lower in dopamine agonist treatment compared to placebo (95% confidence interval (CI) -6.7 to -4.7). Periodic limb movements in sleep per hour of sleep (PLMS-Index; PLMSI) were -22.4/h lower than in placebo (95% CI -27.8 to -16.9). Self rated quality of sleep and disease specific quality of life were improved by a standardised mean difference (SMD) of 0.40 (95% CI 0.33 to 0.47) and 0.34 (95% CI 0.23 to 0.44), respectively. Patients were more likely to drop out (odds ratio (OR) 1.82, 95% CI 1.35 to 2.45) and experienced more adverse events under dopamine agonist treatment than with placebo (OR 1.82, 95% CI 1.59 to 2.08). Visual inspection of forest plots showed the highest efficacy in three studies investigating cabergoline and pergolide (N = 3). Active controlled trials investigated effects of cabergoline, pergolide, and pramipexole in a number of outcomes. The IRLS score was lower with cabergoline and pramipexole compared to levodopa (MD -5.3, 95% CI -8.4 to -2.1). Only four studies investigated treatment efficacy up to seven months. The most severe side effect, augmentation, was not assessed reliably. The meta-analyses show the superiority of dopamine agonists over placebo in RCTs up to seven months. Cabergoline and pramipexole showed larger efficacy compared to levodopa in some but not all outcomes. Comment in ACP Journal Club. Review: Dopamine agonists are effective for the restless legs syndrome but may be discontinued due to adverse events. [Ann Intern Med. 2011] PMID: 21412893 DOI: 10.1002/14651858.CD006009.pub2 [PubMed indexed for MEDLINE] Format: Abstract 1 Author information Publication Types, MeSH Terms, Substances PubMed Full text links Dopamine agonists for restless legs syndrome. PubMed... http://www.ncbi.nlm.nih.gov/pubmed/21412893 1 of 2 8/23/16 1:20 AM
منابع مشابه
Dopamine agonists for the treatment of restless legs syndrome.
The restless legs syndrome is a neurological disorder characterised by the urge to move the extremities associated with paraesthesias, which are partially or totally relieved by movement, a worsening of symptoms at rest and in the evening or at night and, as a consequence, sleep disturbances. Restless legs syndrome is common and affects 1-10% of the population. The aetiology of restless legs sy...
متن کاملRotigotine Transdermal Patch for the Treatment of Restless Legs Syndrome
Rotigotine, a nonergot dopamine agonist, has been developed as a novel transdermal formulation. The rotigotine transdermal patch has received EMA and FDA marketing authorization for the treatment of adult patients with early or advanced Parkinson’s disease or with moderate-to-severe restless legs syndrome (RLS). This review comprises an overview of the pharmacokinetics, the pharmacodynamics and...
متن کاملImbalance between thyroid hormones and the dopaminergic system might be central to the pathophysiology of restless legs syndrome: a hypothesis
Data collected from medical literature indicate that dopaminergic agonists alleviate Restless Legs Syndrome symptoms while dopaminergic agonists antagonists aggravate them. Dopaminergic agonists is a physiological regulator of thyroid-stimulating hormone. Dopaminergic agonists infusion diminishes the levels of thyroid hormones, which have the ability to provoke restlessness, hyperkinetic states...
متن کاملRestless legs syndrome.
Restless legs syndrome is a common neurologic movement disorder that affects approximately 10 percent of adults. Of those affected with this condition, approximately one third have symptoms severe enough to require medical therapy. Restless legs syndrome may be a primary condition, or it may be secondary to iron deficiency, renal failure, pregnancy, or the use of certain medications. The diagno...
متن کاملPathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists.
Pathologic gambling is an impulse control disorder previously reported to complicate dopamine agonist therapy in patients with Parkinson disease. It has not been described in association with dopamine agonist therapy of other conditions. We report three patients treated in our sleep disorders center who developed pathologic gambling while receiving treatment with dopamine agonists for restless ...
متن کامل