In this paper we discuss therapy with ropinirole (known as adartrel in the United Kingdom) in patients with restless legs syndrome. Restless legs syndrome is characterized by an urge to move the legs, uncomfortable sensations in the legs and worsening of these symptoms during rest with at least temporary relief brought on by activity. Current recommendations suggest dopaminergic therapy (levodopa or dopamine receptor agonists like ropinirole) as the first-line treatment for restless legs syndrome. Based on the results of randomized, placebo-controlled, double-blind trials, we conclude that ropinirole is effective in reducing symptoms of restless legs syndrome in the general population. Ropinirole has no serious or common side effects that would limit its use significantly. Rebound and augmentation problems are relatively rarely seen with ropinirole, although properly designed comparative trials are still needed to address this question. It must be noted, however, that most published studies with ropinirole compare this drug with placebo. Very few studies have compared ropinirole with other drugs (L-dopa, gabapentin, opioids, benzodiazepines, other dopaminergic agents and selegiline hydrochloride). No cost-effectiveness trial has been published yet. Treatment of restless legs syndrome with ropinirole shows it to be effective, well-tolerated and safe and it can be used in restless legs syndrome in general.
[Show abstract][Hide abstract] ABSTRACT: An impairment of central somatosensory processing is assumed in restless legs syndrome (RLS). Although functional neuroimaging in RLS gave evidence to the presence of widespread functional changes in various brain areas, structural changes at the cortical level were not reported to be RLS-associated to date. Here, an analysis of high-resolution 3-dimensional magnetic resonance imaging (MRI) was performed in 63 patients with idiopathic RLS by use of optimized voxel-based morphometry, in order to investigate if sensorimotor and pain processing cortical areas might be altered in volume at group level according to the phenomenology of RLS. The comparison of the RLS patients versus controls yielded significant regional decreases of grey matter volume at corrected p < 0.05 in the bihemispheric primary somatosensory cortex which additionally extended into left-sided primary motor areas. All clusters correlated with the severity of RLS symptoms. These results, for the first time, give in vivo evidence to structural neocortical grey matter alterations in RLS patients. The alterations in the sensorimotor cortices might add to the pathophysiological concepts of idiopathic RLS.
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