Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Tweaking the Treatment for Restless Legs

22.12.2006
Last Super Bowl, a TV commercial lauded the power of Requip (ropinirole), the first drug approved to treat restless leg syndrome, a condition whose signature feature is creepy-crawly leg sensations that interfere with sleep and rest in nearly 1 of every 10 adults.

But if taken too long, the drug can actually backfire, causing symptoms to worsen, say doctors who specialize in treating the condition. They say that treatment that rotates through different types of medications may be needed for many patients.

“It’s impossible to tell the whole story in a TV spot just a few seconds long,” said Irene Richard, M.D, a movement disorder neurologist at the University of Rochester Medical Center. “When patients come in asking about the treatment, doctors need to know that this is usually not a simple, single-pill solution, despite what they’ve seen on TV.”

In an article published in the December issue of the Journal of General Internal Medicine, Richard and fellow neurologist Roger Kurlan, M.D., warn primary care physicians that they cannot expect long-term success by simply prescribing ropinirole or a similar medication in its class, which works by activating dopamine receptors in the brain. Instead, the team – experts at treating movement disorders like Parkinson’s disease, Tourette’s syndrome and restless leg syndrome – recommends that physicians may need to rotate some patients through these drugs along with different types of medications.

"The truth is, some of the most common, most effective drugs, including ropinirole and pramipexole, which was recently approved to treat restless leg syndrome, may only work effectively for each person for a limited time,” Kurlan said. “After that, this class of drugs – albeit the most-popular, effective, and the only one approved by the Food and Drug Administration for restless leg syndrome– has a regrettable tendency to turn traitor. The medicine can actually begin to worsen symptoms.”

In their paper, which was written together with nurse practitioner Cheryl Deeley, Richard and Kurlan examine the cases of two older women who have the syndrome. Typically, patients move their legs frequently and are often irked by a life of pacing in the wee morning hours, or in the worst cases, being unable to take road trips or even sit through a movie.

In both cases, and in most other patients the doctors have treated, they have found it helpful to switch the medications that patients receive. Sometimes the medication is no longer useful or helpful. But more often, the approved medications actually began to trigger the symptoms they were supposed to prevent, a phenomenon called augmentation. Richard and Kurlan have seen several patients whose symptoms eased immediately after treatment with the new medications began, but whose symptoms then worsened markedly later.

“At this point, you can’t just up the dose,” Kurlan said, “The drug is part of the problem.”

Augmentation is similar to what occurs when patients use painkillers for an extended period of time to treat their tension headaches. Soon, the medication actually triggers the headaches and worsens them. That’s why such painkillers, though effective in the short term, usually can’t be taken regularly and indefinitely without a painful price.

In their report, the doctors say that the new medication for restless leg syndrome worked in one of the patients for seven months before she had to be switched to other medications. In the other, it worked for a few years before switching was required.

In the wake of FDA approval for Requip and Mirapex (pramipexole), along with the attendant heavy advertising, Kurlan and Richard stress the importance to both primary care physicians and patients alike of understanding the risks of relying on these medications for too long.

“The best drugs for restless leg syndrome sometimes can only work for a time. Then they boomerang,” said Kurlan.

The solution, Kurlan and Richard say, might be to switch things up at just the right time, rotating treatment through several different classes of drugs as problems arise, or perhaps before augmentation even appears. Finessing an ideal rotation is a challenge because it differs from one patient to the next. How long each medication should be used – or not used, a break called a “drug holiday” which may later allow doctors to use them again, effectively – are questions that should be looked at, the doctors say. In one of the cases covered in the report in the Journal of General Internal Medicine, a short break from the new medications allowed doctors to use them effectively for four more months, while in the other, the break afforded just two more months of relief before the patient needed to again be switched to another treatment.

Previous studies typically have not monitored for the problem of augmentation or have been too brief to observe it, but the team hopes more attention will be paid to the issue in research studies.

“Ultimately, there is hope for those who suffer from restless leg syndrome,” Richard said. “But until there’s an effective drug we can use long term without interruption, for many patients hope lies in a merry-go-round of medications, not a single drug. Patients and physicians must be braced for this.”

For more media inquiries, contact:
Becky Jones
(585) 275-8490
rebecca_jones@urmc.rochester.edu

Becky Jones | EurekAlert!
Further information:
http://www.urmc.rochester.edu

More articles from Health and Medicine:

nachricht Investigators may unlock mystery of how staph cells dodge the body's immune system
22.09.2017 | Cedars-Sinai Medical Center

nachricht Monitoring the heart's mitochondria to predict cardiac arrest?
21.09.2017 | Boston Children's Hospital

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Rainbow colors reveal cell history: Uncovering β-cell heterogeneity

22.09.2017 | Life Sciences

Penn first in world to treat patient with new radiation technology

22.09.2017 | Medical Engineering

Calculating quietness

22.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>