Poor effect of guideline based treatment of restless legs syndrome in clinical practice.
BACKGROUND
Numerous randomised controlled trials have proved the efficacy of dopaminergic and non-dopaminergic drugs in the treatment of restless legs syndrome (RLS). In contrast, epidemiological data demonstrate generally insufficient RLS treatment in clinical practice.


OBJECTIVE
To prospectively assess the success of RLS treatment in the clinical setting and to evaluate potential demographic factors and comorbidities that may influence the response to therapy.


METHODS
100 patients with idiopathic RLS (40% had never received RLS specific treatment before) were examined at baseline and after 12 months. Recommendations for therapy according to RLS treatment guidelines of the German Neurological Society were given at baseline. Primary measures for the success of therapy were reduction of RLS symptoms (IRLS) and improvement of quality of life (RLS-QoL).


RESULTS
No statistically significant improvement of IRLS or RLS-QoL was detected after 12 months, in initially untreated or in pretreated patients. Poor treatment success, regarding improvement of RLS symptoms, quality of life and number of RLS related physician contacts was related to the presence of neuropsychiatric comorbidity--that is, somatoform disorders (prevalence 41%), chronic pain (32%), anxiety (20%) and major depression (16%).


CONCLUSIONS
Success of guideline based treatment of RLS appears to be rather poor in clinical practice. Neuropsychiatric comorbidity may be a target for interventions to improve overall outcome.
Godau
Jana
J
Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and Centre of Neurology, University of Tübingen, Germany. jana.godau@medizin.uni-tuebingen.de
Spinnler
Nike
N
Wevers
Anne-Kathrin
AK
Trenkwalder
Claudia
C
Berg
Daniela
D
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D019985:Benchmarking; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015259:Dopamine Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012148:Restless Legs Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D015259:Dopamine Agents