RESUMEN
A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS.
Asunto(s)
Medicina Basada en la Evidencia , Síndrome de Mioclonía Nocturna/terapia , Síndrome de las Piernas Inquietas/terapia , Medicina del Sueño , Academias e Institutos , Benzotiazoles/uso terapéutico , Cabergolina , Carbamatos/uso terapéutico , Dopaminérgicos/uso terapéutico , Ergolinas/uso terapéutico , Humanos , Indoles/uso terapéutico , Levodopa/uso terapéutico , Pergolida/efectos adversos , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Pramipexol , Estados Unidos , Insuficiencia Venosa/tratamiento farmacológico , Ácido gamma-Aminobutírico/análogos & derivados , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
In the group of medication acting on the dopaminergic system the transdermal application of a dopamine agonist (Rotigotine) and a new MAO B inhibitor (Rasigiline) are receiving most attention. With some concern we had to learn that pergolide, a potent dopamine agonist, may be the cause of clinically relevant valvulopathies. Our possibilities to act on non-dopaminergic deficits is still very limited. The studies demonstrating a positive effect of cholinesterase inhibitors on cognitive decline are at least a positive signal.
Asunto(s)
Enfermedad de Parkinson/tratamiento farmacológico , Antiparkinsonianos/efectos adversos , Cannabis , Inhibidores de la Colinesterasa/uso terapéutico , Ensayos Clínicos Controlados como Asunto , Agonistas de Dopamina/efectos adversos , Agonistas de Dopamina/uso terapéutico , Enfermedades de las Válvulas Cardíacas/inducido químicamente , Humanos , Indanos/administración & dosificación , Indanos/uso terapéutico , Levodopa/administración & dosificación , Levodopa/uso terapéutico , Inhibidores de la Monoaminooxidasa/administración & dosificación , Inhibidores de la Monoaminooxidasa/uso terapéutico , Fármacos Neuroprotectores/administración & dosificación , Fármacos Neuroprotectores/uso terapéutico , Enfermedad de Parkinson/fisiopatología , Pergolida/efectos adversos , Fenilcarbamatos/uso terapéutico , Placebos , Rivastigmina , Factores de TiempoRESUMEN
The efficiency of pergolide has been confirmed by the study of a group 29 parkinsonian patients. They were relatively young, and the duration of evolution of their Parkinson's disease was more then ten years, with levodopa-induced dyskinesia and fluctuations. In this group of patients with most serious motor disability, it has been possible to improve dyskinesia and fluctuations with a relatively important dosage of pergolide and without increase of levodopa dosage.