Winkelman John W, Armstrong Melissa J, Allen Richard P, Chaudhuri K Ray, Ondo William, Trenkwalder Claudia, Zee Phyllis C, Gronseth Gary S, Gloss David, Zesiewicz Theresa
From Harvard Medical School and Massachusetts General Hospital (J.W.W.), Boston; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (R.P.A.), Johns Hopkins University, Baltimore, MD; King's College and King's College Hospital (K.R.C.), London; Methodist Neurological Institute (W.O.), Houston, TX; Department of Neurology (C.T.), University Medical Center, Göttingen, Germany; Northwestern University Feinberg School of Medicine (P.C.Z.), Chicago, IL; University of Kansas Medical Center (G.S.G.), Kansas City; CAMC Neurology Section (D.G.), Charleston, WV; and Department of Neurology (T.Z.), University of South Florida, James A Haley Veterans Administration Hospital, Tampa.
Neurology. 2016 Dec 13;87(24):2585-2593. doi: 10.1212/WNL.0000000000003388. Epub 2016 Nov 16.
To make evidence-based recommendations regarding restless legs syndrome (RLS) management in adults.
Articles were classified per the 2004 American Academy of Neurology evidence rating scheme. Recommendations were tied to evidence strength.
In moderate to severe primary RLS, clinicians should consider prescribing medication to reduce RLS symptoms. Strong evidence supports pramipexole, rotigotine, cabergoline, and gabapentin enacarbil use (Level A); moderate evidence supports ropinirole, pregabalin, and IV ferric carboxymaltose use (Level B). Clinicians may consider prescribing levodopa (Level C). Few head-to-head comparisons exist to suggest agents preferentially. Cabergoline is rarely used (cardiac valvulopathy risks). Augmentation risks with dopaminergic agents should be considered. When treating periodic limb movements of sleep, clinicians should consider prescribing ropinirole (Level A) or pramipexole, rotigotine, cabergoline, or pregabalin (Level B). For subjective sleep measures, clinicians should consider prescribing cabergoline or gabapentin enacarbil (Level A), or ropinirole, pramipexole, rotigotine, or pregabalin (Level B). For patients failing other treatments for RLS symptoms, clinicians may consider prescribing prolonged-release oxycodone/naloxone where available (Level C). In patients with RLS with ferritin ≤75 μg/L, clinicians should consider prescribing ferrous sulfate with vitamin C (Level B). When nonpharmacologic approaches are desired, clinicians should consider prescribing pneumatic compression (Level B) and may consider prescribing near-infrared spectroscopy or transcranial magnetic stimulation (Level C). Clinicians may consider prescribing vibrating pads to improve subjective sleep (Level C). In patients on hemodialysis with secondary RLS, clinicians should consider prescribing vitamin C and E supplementation (Level B) and may consider prescribing ropinirole, levodopa, or exercise (Level C).
针对成人不宁腿综合征（RLS）的管理提出基于证据的建议。
文章根据2004年美国神经病学学会的证据评级方案进行分类。建议与证据强度相关联。
在中度至重度原发性RLS中，临床医生应考虑开处药物以减轻RLS症状。有力证据支持使用普拉克索、罗替戈汀、卡麦角林和加巴喷丁酯（A级）；中等证据支持使用罗匹尼罗、普瑞巴林和静脉注射羧麦芽糖铁（B级）。临床医生可考虑开处左旋多巴（C级）。很少有直接比较表明哪种药物更具优势。卡麦角林很少使用（存在心脏瓣膜病风险）。应考虑多巴胺能药物的增敏风险。在治疗睡眠期周期性肢体运动时，临床医生应考虑开处罗匹尼罗（A级）或普拉克索、罗替戈汀、卡麦角林或普瑞巴林（B级）。对于主观睡眠指标，临床医生应考虑开处卡麦角林或加巴喷丁酯（A级），或罗匹尼罗、普拉克索、罗替戈汀或普瑞巴林（B级）。对于RLS症状经其他治疗无效的患者，临床医生可考虑在有条件时开处缓释羟考酮/纳洛酮（C级）。对于铁蛋白≤75μg/L的RLS患者，临床医生应考虑开处硫酸亚铁加维生素C（B级）。当希望采用非药物方法时，临床医生应考虑开处气压治疗（B级），也可考虑开处近红外光谱或经颅磁刺激（C级）。临床医生可考虑开处振动垫以改善主观睡眠（C级）。对于接受血液透析的继发性RLS患者，临床医生应考虑补充维生素C和E（B级），也可考虑开处罗匹尼罗、左旋多巴或进行运动（C级）。
