10 Although many patients benefit from currently available medications, side effects and suboptimal efficacy are not uncommon, suggesting the need for exploration of novel treatment avenues. 9 Tramadol has also been associated with augmentation. 7, 8 Opiates and opioids have been used in refractory cases, 6 but they also can be associated with significant side effects, including somnolence, imbalance, nausea, constipation, pruritis, tolerance, addiction, and respiratory depression. This complication remains a common cause of severe refractory RLS, given that it occurs in 40% to 70% of patients taking pramipexole or ropinirole in 10 years. Augmentation can occur after prolonged use of dopaminergic agents and is characterized by reduced efficacy, earlier daytime appearance of symptoms, and symptom spread to the upper extremities or other parts of the body with increasing doses of the drugs. Non-ergot dopaminergic agonists can cause impulse control disorders and augmentation. Alpha-2-delta ligands can result in fatigue, somnolence, dizziness, balance issues, peripheral edema, depression, weight gain, possible worsening of sleep-disordered breathing, and abuse. Unfortunately, pharmacological therapy for RLS is not always well tolerated, particularly in older adults. Opiates and opioids are reserved for patients who are refractory to first-line medications. 4, 5 Treatment options for patients with chronic persistent RLS include iron replacement (if levels are suboptimal), alpha-2-delta ligands (gabapentin, gabapentin enacarbil, or pregabalin), and non-ergot dopaminergic agonists (pramipexole, ropinirole, or rotigotine patch). The overall prevalence of RLS ranges between 2.5% and 10%, 3 of which 1.5% to 2.7% is associated with moderate to severe symptoms occurring at least twice weekly. 1, 2 The symptoms can cause severe insomnia, poor sleep quality, anxiety, depression, and impulsivity, resulting in significant daytime dysfunction, quality-of-life impairment, increased suicide risk, and increased risk of all-cause death. Restless legs syndrome (RLS) is a sensorimotor condition characterized and diagnosed clinically by its core symptoms: an uncontrollable urge to move, often associated with unpleasant sensation of the legs, which is worsened by inactivity predominantly in the evening or night and relieved by movement. RLS, spinal cord stimulator, neuromodulation, neurostimulation Introduction
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |