1] Paracelsus Elena Klinik, Centre of Parkinsonism and Movement Disorders, Kassel, Klinikstrasse 16, 34128 Kassel, Germany. [2] Department of Neurosurgery, University Medical Centre Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
1] Department of Neurology and Neurological Sciences and Centre for Sleep Sciences and Medicine, Stanford University, 3165 Porter Drive Palo Alto, CA 94304, USA. [2] Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
Nat Rev Neurol. 2015 Aug;11(8):434-45. doi: 10.1038/nrneurol.2015.122. Epub 2015 Jul 28.
Idiopathic restless legs syndrome (RLS) can severely affect quality of life and disturb sleep, so that pharmacological treatment is necessary, especially for elderly patients. Treatment guidelines recommend initiation of therapy with dopamine agonists (pramipexole, ropinirole or the rotigotine transdermal patch, all approved in most countries) or α-2-δ ligands (gabapentin enacarbil, approved in the USA and Japan), depending on the country and availability. Where approved, opioids (prolonged release oxycodone-naloxone, approved in Europe) are also recommended as a second-line therapy for severe RLS. Several iron formulations can be effective but are not yet approved for RLS therapy, whereas benzodiazepines and other anticonvulsants are not recommended or approved. Less is known about effective management of RLS that is associated with other conditions, such as uraemia or pregnancy. Furthermore, very little data are available on the management of RLS when first-line treatment fails or patients experience augmentation. In this Review, we summarize state-of-the-art therapies for RLS in the context of the diagnostic criteria and available guidelines, based on knowledge ranging from Class I evidence for the treatment of idiopathic RLS to Class IV evidence for the treatment of complications such as augmentation. We consider therapies, including combination therapies, that are used in clinical practice for long-term management of RLS, despite a lack of trials and approval, and highlight the need for practical long-term evaluation of current trials.
特发性不宁腿综合征（RLS）可严重影响生活质量并扰乱睡眠，因此需要进行药物治疗，尤其是老年患者。治疗指南建议根据国家和药物可及性，选择多巴胺受体激动剂（普拉克索、罗匹尼罗或罗替高汀透皮贴剂，均在大多数国家获得批准）或α-2-δ 配体（加巴喷丁恩卡比，仅在美国和日本获得批准）作为起始治疗药物。在获得批准的国家，阿片类药物（长效释放羟考酮-纳洛酮，仅在欧洲获得批准）也被推荐作为严重 RLS 的二线治疗药物。几种铁制剂可能有效，但尚未批准用于 RLS 治疗，而苯二氮䓬类药物和其他抗惊厥药不推荐或不批准用于 RLS 治疗。对于与其他疾病相关的 RLS 的有效治疗方法知之甚少，例如尿毒症或妊娠。此外，对于一线治疗失败或出现药物增效时 RLS 的管理，仅有很少的数据。在这篇综述中，我们根据治疗特发性 RLS 的 I 级证据到治疗增效等并发症的 IV 级证据等知识，在诊断标准和现有指南的背景下总结了 RLS 的最新治疗方法。我们考虑了在缺乏试验和批准的情况下，用于 RLS 长期管理的联合治疗等治疗方法，并强调需要对当前试验进行实际的长期评估。
