title: Chronic dopaminergic treatment in restless legs syndrome: does it affect the autonomic nervous system?
abstract: OBJECTIVE
  The link between the autonomic nervous system and restless legs syndrome (RLS) has been recently postulated. Since dopaminergic agents are used as first-line treatment for RLS, the purpose of our study is to verify whether chronic pramipexole treatment could influence the autonomic control of cardiovascular reflexes and heart rate variability (HRV) in RLS during wakefulness.
  
  
  METHODS
  Consecutive drug naive RLS patients underwent polysomnography (PSG), subjective scales, and cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, handgrip and cold face before and after 3-month pramipexole therapy. HRV analysis was performed in the frequency domain using both autoregressive and fast Fourier transform algorithms in rest supine condition and during HUTT.
  
  
  RESULTS
  Twenty RLS patients reported a significant reduction of RLS symptoms after pramipexole treatment, while PSG did not show significant improvements except for periodic limb movement index. Pramipexole induced a trend to a lower systolic blood pressure and a significant higher variation of systolic and diastolic blood pressure at HUTT. Cardiovascular responses to the other tests were unchanged. No significant differences in HRV spectral analysis between drug naive and treated patients were observed. Moreover, the within-group analysis of HRV between orthostatic and supine position did not show any significant change in sympathetic and parasympathetic components both in the drug naive and pramipexole groups.
  
  
  CONCLUSIONS
  Chronic pramipexole treatment does not seem to affect autonomic balance during wakefulness. Considering that neither PSG data nor autonomic parameters are significantly modified by pramipexole, we hypothesize a non-dopaminergic autonomic dysfunction in RLS.
authors: Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Camilla
authors: C
authors: Rocchi
authors: Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Maria
authors: M
authors: Albanese
authors: Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Fabio
authors: F
authors: Placidi
authors: Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Andrea
authors: A
authors: Romigi
authors: Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Benedetta
authors: B
authors: Lauretti
authors: Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Girolama A
authors: GA
authors: Marfia
authors: Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Claudio
authors: C
authors: Liguori
authors: Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors: Maria G
authors: MG
authors: Marciani
authors: Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Fondazione Santa Lucia IRCCS, Rome, Italy.
authors: Nicola B
authors: NB
authors: Mercuri
authors: Neurophysiopathology Unit, Sleep Medicine Center, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy. Electronic address: fraizzi@tin.it.
authors: Francesca
authors: F
authors: Izzi
mesh_terms: D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D052160:Benzothiazoles / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D000077487:Pramipexole; D012148:Restless Legs Syndrome / Q000188:drug therapy* / Q000503:physiopathology*; D014851:Wakefulness / Q000502:physiology
chemical_list: D052160:Benzothiazoles; D018491:Dopamine Agonists; D000077487:Pramipexole
keywords: Autonomic nervous system; Cardiovascular reflexes; Heart rate variability; Pramipexole; Restless legs syndrome; Sleep