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 | EurekAlert!
Study tracks inner workings of the brain with new biosensor
16.08.2018 | Rheinische Friedrich-Wilhelms-Universität Bonn
Foods of the future
15.08.2018 | Georg-August-Universität Göttingen
New design tool automatically creates nanostructure 3D-print templates for user-given colors
Scientists present work at prestigious SIGGRAPH conference
Most of the objects we see are colored by pigments, but using pigments has disadvantages: such colors can fade, industrial pigments are often toxic, and...
Scientists at the University of California, Los Angeles present new research on a curious cosmic phenomenon known as "whistlers" -- very low frequency packets...
Scientists develop first tool to use machine learning methods to compute flow around interactively designable 3D objects. Tool will be presented at this year’s prestigious SIGGRAPH conference.
When engineers or designers want to test the aerodynamic properties of the newly designed shape of a car, airplane, or other object, they would normally model...
Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.
Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....
Proteins must be folded correctly to fulfill their molecular functions in cells. Molecular assistants called chaperones help proteins exploit their inbuilt folding potential and reach the correct three-dimensional structure. Researchers at the Max Planck Institute of Biochemistry (MPIB) have demonstrated that actin, the most abundant protein in higher developed cells, does not have the inbuilt potential to fold and instead requires special assistance to fold into its active state. The chaperone TRiC uses a previously undescribed mechanism to perform actin folding. The study was recently published in the journal Cell.
Actin is the most abundant protein in highly developed cells and has diverse functions in processes like cell stabilization, cell division and muscle...
17.08.2018 | Event News
08.08.2018 | Event News
27.07.2018 | Event News
17.08.2018 | Physics and Astronomy
17.08.2018 | Information Technology
17.08.2018 | Life Sciences