Restless legs syndrome

Department of Neurology and Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
BMJ (online) (Impact Factor: 17.45). 05/2012; 344(may23 2):e3056. DOI: 10.1136/bmj.e3056
Source: PubMed
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Available from: Guy D Leschziner, Jan 20, 2014
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    • "Falling asleep can be disturbed by a restless legs syndrome (RLS), defined by four essential criteria: an urge to move the legs, usually accompanied by unpleasant sensations; worsening during periods of rest or inactivity; a partial or total relief by movement, and worsening in the evening or during the night (Allen et al., 2003; Leschziner and Gringras, 2012). While some case reports suggest that clozapine (Duggal and Mendhekar, 2007; Chathanchirayil, 2011) or olanzapine (Kraus et al., 1999; Kang et al., 2009; Khalid et al., 2009; Aggarwal et al., 2010) may be associated with RLS, corresponding prospective studies are lacking. "
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    ABSTRACT: Schizophrenia is associated with impaired sleep continuity. The second generation antipsychotics clozapine and olanzapine have been reported to improve sleep continuity but also to rarely induce restless legs syndrome (RLS). The aims of this randomized double-blind study were to compare the effects of clozapine and olanzapine on sleep and the occurrence of RLS. Therefore, polysomnographies were recorded and RLS symptoms were assessed in 30 patients with schizophrenia before and after 2, 4 and 6weeks of treatment with either clozapine or olanzapine. Treatment with both antipsychotics increased total sleep time, sleep period time and sleep efficiency and decreased sleep onset latency. These changes were similar in both groups, occurred during the first 2 treatment weeks and were sustained. For example, sleep efficiency increased from 83% (olanzapine) and 82% (clozapine) at baseline to 95% at week 2 and 97% at week 6 in both treatment groups. Sleep architecture was differently affected: clozapine caused a significantly stronger increase of stage 2 sleep (44%) than olanzapine (11%) but olanzapine a significantly stronger increase of REM-sleep. Olanzapine caused an 80% increase of slow wave sleep whereas clozapine caused a 6% decrease. No patient reported any of 4 RLS defining symptoms at baseline. During treatment, 1 patient of each group reported at one visit all 4 symptoms, i.e. met the diagnosis of an RLS. In conclusion, sleep continuity similarly improved and sleep architecture changed more physiologically with olanzapine. Neither of the antipsychotics induced RLS symptoms that were clinically relevant.
    Schizophrenia Research 12/2013; 152(1). DOI:10.1016/j.schres.2013.11.009 · 3.92 Impact Factor
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    ABSTRACT: Oral gabapentin enacarbil is approved in adult patients for the treatment of moderate to severe primary restless legs syndrome (RLS) [featured indication] and the management of postherpetic neuralgia. In the 12-week Patient Improvements in Vital Outcomes following Treatment (PIVOT) RLS I and II trials in adult patients with moderate to severe primary RLS (n > 500 total evaluable), once-daily gabapentin enacarbil 600 or 1,200 mg significantly improved mean International Restless Legs Scale (IRLS) total scores compared with placebo, with significantly higher investigator-rated Clinical Global Impression-Improvement (CGI-I) responder rates in gabapentin enacarbil groups than in placebo groups. Improvements in other sleep outcomes (assessed using various scales) also generally favoured gabapentin enacarbil treatment. These data are supported by results from a polysomnography, crossover (two 4-week treatment periods) trial (n > 100 evaluable). Improvements in RLS symptoms with gabapentin enacarbil were maintained in a 52-week extension study of clinical trials, including PIVOT RLS I and II. The longer-term efficacy of gabapentin enacarbil in patients with moderate to severe RLS was also demonstrated in the 36-week PIVOT RLS Maintenance study and a 52-week noncomparative study conducted in Japan. Gabapentin enacarbil was generally well tolerated in adult patients with RLS participating in short- and longer-term clinical trials. The most common treatment-emergent adverse events were somnolence/sedation and dizziness. Most adverse events were of mild to moderate severity, with relatively few patients discontinuing treatment because of an adverse event.
    CNS Drugs 11/2012; 26(12). DOI:10.1007/s40263-012-0020-3 · 5.11 Impact Factor
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    ABSTRACT: Objective: A single-blind randomized controlled trial was conducted to test the efficacy of Longden's counterstrain technique for restless legs syndrome (RLS). Methods: Participants were adults with moderate-to-severe and persistent RLS, randomized to receive either active or control intervention. The control intervention (B) involved in counterstrain manipulation applied to the lower half of the body. The active intervention (A) was identical to the control intervention plus specific modifications to treat RLS as described by Longden. The success of blinding of participants was confirmed by a questionnaire. Results: Thirty-nine patients entered the trial, 20 assigned to Group A and 19 to Group B. All patients were included in the intention-to-treat analysis. The primary outcome measure, the change on the International Restless Legs Scale total score at 6 weeks, showed a statistically significant difference of 8.06 points (95% confidence interval 3.15-12.96) between groups. This represented an improvement of 42.2% in the active group compared to 8.7% in the controls. No adverse effects were reported. Conclusions: Longden's RLS-specific counterstrain treatment had a clinically important effect at 6 weeks. Trials of longer-term effects and comparison with the standard drug regimes are now required. © W.S. Maney & Son Ltd. and the British Institute of Musculoskeletal Medicine 2012.
    International Musculoskeletal Medicine 12/2012; 34(4):136-140. DOI:10.1179/1753615412Y.0000000011
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