``Pramipexole is the most potent therapeutic agent ever tested for RLS,''
write an international team of researchers led by Dr. Jacques Montplaisir of
the Sleep Studies Center at the Hopital du Sacr-Coeur de Montreal in Quebec,
Canada. Their findings were published in the journal Neurology.
RLS is characterized by recurrent tingling, burning sensations in the lower
limbs and an irresistible urge -- especially when at rest -- to move the
legs. The syndrome can cause chronic sleep deprivation and resultant
fatigue.
Experts have recently linked the illness with reduced activity of the
neurochemical dopamine within the brain. Reduced levels of dopamine in the
brain causes another more serious neuromotor disorder -- Parkinson's
disease.
In their study, Montplaisir's team had 10 RLS patients receive pramipexole
or (an inactive) placebo over two 4-week periods. Pramipexole, which mimics
the effects of dopamine, has already proven effective in reducing the
symptoms of Parkinson's disease.
The authors report that ``nine out of the 10 patients in this study reported
a complete disappearance of RLS symptoms with pramipexole.'' The tenth
patient also reported ``a major improvement of symptoms,'' according to the
investigators.
Most patients experienced mild and short-term (1 week) gastrointestinal side
effects related to use of the drug, including nausea and vomiting.
Based on their findings, the researchers conclude that pramipexole therapy
represents a powerful new method of controlling RLS symptoms.
In a related study in the same issue of Neurology, German researchers tested
the effectiveness of 4 weeks of another dopamine-related drug, pergolide, in
a group of 30 RLS patients. They report that the drug appears to be ``a
well-tolerated and effective treatment of (restless leg) symptoms and sleep
disturbances in patients with primary RLS.''
In their commentary on the findings of both studies, Dr. Sudhansu
Chokroverty of Saint Vincent's Hospital and Medical Center in New York City,
and Dr. Joseph Jankovic of the Baylor College of Medicine in Houston, Texas,
note that RLS too often goes undetected and untreated.
``Persons with RLS, even when their symptoms are quite troublesome or
disabling, often do not seek medical attention,'' they point out, ``or the
symptoms are wrongly attributed by physicians to nervousness, insomnia,
stress'' or other conditions.
The two experts believe that both patients and physicians need to recognize
RLS as a distinct physical disorder. They believe that more studies with
larger numbers of participants are also needed ``to find the best treatments
for these patients.''
SOURCE: Neurology 1999;52:907-910, 938-943, 944-950.