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      Treatment of restless legs syndrome Translated title: Tratamento da síndrome das pernas inquietas

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          Abstract

          OBJECTIVE: Restless legs syndrome is a neurological disorder characterized by a desire to move limbs, which is usually only present or worsens during rest or at night. The objective of this article was to review the available literature about pharmacological treatment for this disorder. METHOD: A search of recent literature was undertaken on online databases (Medline, Pubmed, Scielo and Lilacs). RESULTS: 502 articles were retrieved, of which 30 were selected. Dopaminergic agents, anticonvulsants, opioids, benzodiazepines, zolpidem, entacapone and ketamine were all effective on the restless legs syndrome treatment. One study showed that iron was not effective. CONCLUSIONS: Based on few double-blind, randomized, controlled trials, it seems that the best options to treat restless legs syndrome patients are gabapentin and L-dopa associated to its sustained release formulation.

          Translated abstract

          OBJETIVO: A síndrome das pernas inquietas é um transtorno neurológico caracterizado por um desejo incontrolável de mover os membros, que comumente está somente presente ou piora ao descanso ou à noite. O objetivo do trabalho foi a revisão da literatura disponível sobre o tratamento farmacológico para a síndrome das pernas inquietas. MÉTODO: Pesquisa da literatura recente realizada em bases de dados eletrônicas (Medline, Pubmed, Scielo e Lilacs). RESULTADOS: Quinhentos e dois artigos foram encontrados, dos quais 30 foram selecionados. Os agentes dopaminérgicos, os anticonvulsantes, os opióides, os benzodiazepínicos, o zolpidem, o entacapone e a ketamina foram eficazes no tratamento da síndrome das pernas inquietas. Um estudo mostrou que o ferro não foi eficaz. CONCLUSÕES: Baseado nos poucos estudos duplo-cegos, randomizados e controlados, parece que as melhores opções para tratar os pacientes com síndrome das pernas inquietas são a gabapentina e L-dopa associada à sua formulação de liberação lenta.

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          Most cited references50

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          A Randomized, Double-Blind Placebo-Controlled Trial of Iron in Restless Legs Syndrome

          Background: Previous open-label trials have shown iron to be efficacious in the treatment of restless legs syndrome. We performed a randomized, double-blind, placebo-controlled trial of iron sulfate. Methods: Twenty-eight patients were randomized to receive either ferrous sulfate 325 mg b.i.d. or placebo for 12 weeks. The primary outcome measure was the dichotomous variable of improvement or no improvement in average quality of sleep as recorded by a visual analog scale nightly over a 2-week period, comparing a pretreatment 2-week baseline to weeks 13–14. Secondary outcome measures included a comparison of the quality of sleep as measured by a visual analog scale, effect of restless legs syndrome on life as a whole as measured by a different visual analog scale, and the percentage of nights patients were symptomatic. Results: No significant differences were noted between iron and placebo groups for both primary and secondary outcome measures. Responders taking iron did have a significant increase in their iron saturation compared to nonresponders taking iron. Conclusions: Iron sulfate does not appear to be an effective empiric treatment for restless legs syndrome.
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            Clinical symptoms and possible anticipation in a large kindred of familial restless legs syndrome.

            Idiopathic restless legs syndrome (RLS) frequently follows an autosomal dominant inheritance with a variable clinical expressivity of symptoms. We describe the largest German kindred of familial RLS with 20 affected and investigated members in four generations with a variety of clinical symptoms. Patients were examined clinically, and polysomnography was performed in selected cases. The diagnosis was set according to the diagnostic criteria of the International RLS Study Group. All patients showed sensory symptoms of their legs and a worsening of symptoms with increasing age. Older patients, who needed treatment, responded well to opioids. Segregation ratios were close to 0.5, confirming a virtually complete penetrance. The mean age of onset fell from 51.5 years in the second generation to 19.8 years in the fourth generation (ANOVA, p = 0.025). The identification of presymptomatic carriers in the fourth generation in the following years, however, may prejudice this result. This large family showed the variety of clinical RLS symptoms with decreasing age of onset in generations II-IV, suggesting at least the possibility of anticipation.
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              Acute placebo-controlled sleep laboratory studies and clinical follow-up with pramipexole in restless legs syndrome.

              In a single-blind, placebo-controlled crossover trial, the acute efficacy of the dopamine agonist pramipexole was investigated in 11 restless legs syndrome (RLS) patients by sleep laboratory methods, with a clinical follow-up for 4 weeks. In 3 nights (pre-treatment, placebo and drug night), objective sleep quality was determined by polysomnography (PSG), subjective sleep and awakening quality by rating scales, objective awakening quality by psychometry. Clinical follow-up consisted of completion of the International RLS Study Group (IRLSSG) Scale, Zung Depression (SDS) and Anxiety (SAS) Scale, Quality of Life Index, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Concerning acute effects, an omnibus significance test for PSG variables demonstrated a global difference between placebo and pramipexole, but none between pre-treatment and placebo. Pramipexole 0.27 mg significantly decreased the target variable periodic leg movements (PLM)/h of sleep as well as all other RLS/PLM variables and improved objective sleep efficiency and subjective sleep quality as compared with placebo. In sleep architecture, sleep stages S1 and S2 and stage shifts increased, while slow-wave sleep and SREM decreased. After 4 weeks of therapy, the total scores of the IRLSSG questionnaire, sleep quality and daytime sleepiness, depression and quality of life also improved. Thus, acute pramipexole markedly reduced PLM measures and slightly improved objective and subjective sleep quality. Follow-up ratings showed a moderate improvement of RLS and sleep quality, and to a lesser extent of daytime sleepiness, depression and quality of life. The psychopathological findings as well as acute sleep architecture changes are reminiscent of those seen after activating antidepressants.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbp
                Revista Brasileira de Psiquiatria
                Rev. Bras. Psiquiatr.
                Associação Brasileira de Psiquiatria - ABP (São Paulo )
                1809-452X
                December 2006
                : 28
                : 4
                : 308-315
                Affiliations
                [1 ] Escola Bahiana de Medicina e Saúde Pública Brazil
                Article
                S1516-44462006000400012
                10.1590/S1516-44462006000700012
                d679105d-e495-4f9b-b150-b7fdb95bfd5c

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-4446&lng=en
                Categories
                PSYCHIATRY

                Clinical Psychology & Psychiatry
                Restless legs syndrome,Parasomnias,Sleep disorders,Treatment,Literature review,Síndrome das pernas inquietas,Parassonias,Transtornos do sono,Tratamento,Literatura de revisão

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