Ferini_EU Neurology 09/03/2010 11:52 Page 87
Treatment of Restless Legs Syndrome
clinically relevant augmentation of 1.5% (versus 0.5% in the placebo suitability of rotigotine for some patients; otherwise, the tolerability and
group) over six months in double-blind conditions
63
and of 2.9% over 12 safety of the rotigotine patch is similar to or better than the oral non-
months in the open-label study.
64
However, none of these patients ergot dopamine agonists.
discontinued the treatment because of augmentation.
In the last few years, some surveys have shown that there is a significant
Conclusion association between certain health factors and RLS. In severe RLS, a
Like many chronic disorders, RLS varies considerably in terms of both significant relationship with health problems such as cardiovascular
symptom severity and degree of impact on health and wellbeing. In diseases and hypertension has been found.
65–68
Sleep loss and the
patients with mild RLS, good sleep hygiene should be recommended. presence of PLMS might explain the increased cardiovascular risk in RLS
Patients should be advised to avoid alcohol, caffeine or heavy meals patients, and this increased risk may also help to justify the
before going to sleep. Bedtime hours should be regular and activity pharmacological treatment of moderate/severe RLS cases. n
gradually reduced in the evening. Pharmacological treatment should be
limited to those patients who suffer from clinically relevant RLS
Luigi Ferini-Strambi is an Associate Professor of General
symptoms. Most patients with idiopathic RLS respond robustly to
Psychology and a Professor of Psychobiology of Sleep
dopaminergic agents. The best strategy is to start pharmacological
at the Vita-Salute San Raffaele University, and Head of
therapy cautiously and at the lowest recommended doses.
the Sleep Disorders Centre in the Department of
Neuroscience at the H San Raffaele Scientific Institute
Augmentation, mainly characterised by the occurrence of RLS
in Milan. He is a member of several national and
symptoms earlier in the day, is a phenomenon that may be observed
international scientific societies and is Past President
with dopamine agonists.
of the Italian Association of Sleep Medicine.
Recent papers agree in defining rotigotine as a well tolerated drug with
Mauro Manconi is a Clinical Researcher at the Sleep
Disorders Centre of the San Raffaele Scientific Institute of
good efficacy in idiopathic RLS, with control of both daytime and Milan. His main activities are the diagnosis and
nocturnal symptoms even at long-term follow-up intervals. The dose
management of sleep disorders, the education of the
used in published studies ranges between 0.5 and 4mg/24 hours;
university medical school students (psychologists, nurses
and physicians) and research, which is mostly focused
however, the European Medicines Agency (EMA)-approved dose ranges on the impact of restless legs syndrome and periodic
between 1 and 3mg/24 hours. The constant drug concentrations over 24
limb movement disorder on the cardiovascular system,
hours seem to be a favourable strategy to also cover daytime symptoms
and on the cortical electroencephalogram activity.
and to avoid augmentation. Application-site reactions may limit the
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EUROPEAN NEUROLOGICAL REVIEW 87
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