Choose treatment for restless legs syndrome based on patient and drug characteristics
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Choose treatment for restless legs syndrome based on patient and drug characteristics Esther S. Kim1 · Katherine A. Lyseng‑Williamson1 Published online: 3 September 2020 © Springer Nature Switzerland AG 2020
Abstract Restless legs syndrome (RLS; also known as Willis-Ekbom disease) is a common neurological, sensorimotor disorder. RLS is initially managed with lifestyle modifications, elimination of possible iatrogenic contributors and maintenance of normal-high peripheral iron stores. Moderate-to-severe RLS may be treated with pharmacological therapy, which generally involves the use of α-2-δ ligands (e.g. gabapentin enacarbil, pregabalin, gabapentin) and dopamine agonists (e.g. pramipexole, rotigotine, ropinirole), as well as opioids for treatment-resistant RLS. The chosen drug class/specific drug depends on patient factors (e.g. the most prominent symptoms, comorbidities, age-related issues, preferences) and drug factors (e.g. tolerability profile, augmentation risk).
Common and progressive condition Restless legs syndrome (RLS; also known as Willis-Ekbom disease) is a common neurological, sensorimotor disorder characterized by an irresistible urge to move the legs, usually in response to unpleasant leg sensations (e.g. creeping, crawling, itching, pulling, throbbing) [1–3]. Although the arms and/or other parts of the body may be involved, the legs are usually firstly and most severely affected [4]. RLS symptoms begin or worsen during periods of inactivity or rest, are worse during the evening or night, and are partially or fully relieved by movement [2]. However, symptoms may progress to a point where they are no longer confined to the evening or night and no longer relieved by movement [2]. An estimated 7–10% of the US population have RLS [3]. Although RLS can start at any age, middle-aged or older individuals tend to be more severely affected than younger individuals, and symptoms generally become more frequent and longer lasting with age [3]. It is also more common in Parkinson’s disease (PD) patients than in the general population [5]. RLS can reduce sleep quality and quantity, impair daytime functioning, increase the risk of falls (especially in older adults because of night-time ambulation), and decrease * Katherine A. Lyseng‑Williamson [email protected] 1
Springer Nature, Private Bag 65901, Mairangi Bay, Auckland 0754, New Zealand
health-related quality of life (HR-QoL) [1, 3]. By the time most patients seek treatment (usually in their fifth or sixth decade of life), daily preventative pharmacotherapy is usually needed [1]. This article summarizes the pharmacological management of RLS [1, 2, 5].
Diagnose based on patient history RLS is diagnosed based on history alone, without the need for ancillary testing [1]. For a diagnosis of RLS, a patient must meet the five criteria shown in Fig. 1, with these features not able to be solely accounted for as symptoms of another behavioural or medical condition (e.g. arthritis, habitual foot tapping, leg cramps, leg oedema, myalgia, positional di
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