Polysomnographic record and successful management of augmentation in restless legs syndrome/Willis-Ekbom disease.
BACKGROUND
Dopamine agonists (DAs) represent the first-line treatment in restless legs syndrome (RLS); however, in the long term, a substantial proportion of patients will develop augmentation, which is a severe drug-related exacerbation of symptoms and the main reason for late DA withdrawal. Polysomnographic features and mechanisms underlining augmentation are unknown. No practice guidelines for management of augmentation are available.


METHODS
A clinical case series of 24 consecutive outpatients affected by RLS with clinically significant augmentation during treatment with immediate-release DA was performed. All patients underwent a full-night polysomnographic recording during augmentation. A switchover from immediate-release DAs (l-dopa, pramipexole, ropinirole, rotigotine) to the long-acting, extended-release formula of pramipexole was performed.


RESULTS
Fifty percent of patients presented more than 15 periodic limb movements per hour of sleep during augmentation, showing longer sleep latency and shorter total sleep time than subjects without periodic limb movements. In all patients, resolution of augmentation was observed within two to four weeks during which immediate-release dopamine agonists could be completely withdrawn. Treatment efficacy of extended-release pramipexole has persisted, thus far, over a mean follow-up interval of 13 months.


CONCLUSIONS
Pramipexole extended release could be an easy, safe, and fast pharmacological option to treat augmentation in patients with restless legs syndrome. As such it warrants further prospective and controlled investigations. This observation supports the hypothesis that the duration of action of the drug plays a key role in the mechanism of augmentation.
Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
Michelangelo
M
Maestri
Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
Stephany
S
Fulda
Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy.
Luigi
L
Ferini-Strambi
Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy.
Marco
M
Zucconi
Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy.
Sara
S
Marelli
Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
Claudio
C
Staedler
University Department of Neurology, Inselspital, Bern, Switzerland.
Claudio L
CL
Bassetti
Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland. Electronic address: mauro.manconi@eoc.ch.
Mauro
M
Manconi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052160:Benzothiazoles / Q000008:administration & dosage / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D000077487:Pramipexole; D012148:Restless Legs Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology; D013764:Tetrahydronaphthalenes / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome
D052160:Benzothiazoles; D003692:Delayed-Action Preparations; D018491:Dopamine Agonists; D007211:Indoles; D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C046649:ropinirole; D007980:Levodopa; D000077487:Pramipexole; C047508:rotigotine
Augmentation; Dopamine; Periodic limb movements; Restless legs syndrome; Sleep; Therapy