Opioids for restless legs syndrome

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dc.contributor.authorde Oliveira, Cesar Osorio [UNIFESP]
dc.contributor.authorCarvalho, Luciane Bizari Coin [UNIFESP]
dc.contributor.authorCarlos, Karla
dc.contributor.authorConti, Cristiane Fiquene
dc.contributor.authorde Oliveira, Marcio Moysés
dc.contributor.authorPrado, Lucila Bizari Fernandes.
dc.contributor.authorPrado, Gilmar Fernandes [UNIFESP]
dc.date.accessioned2019-01-21T10:29:50Z
dc.date.available2019-01-21T10:29:50Z
dc.date.issued2016
dc.description.abstractBackground Restless legs syndrome (RLS) is a distressing and common neurological disorder that may have a huge impact in the quality of life of those with frequent and intense symptoms. Patients complain of unpleasant sensations in the legs, at or before bedtime, and feel an urge to move the legs, which improves with movement, such as walking. Symptoms start with the patient at rest (e.g. sitting or lying down), and follow a circadian pattern, increasing during the evening or at night. Many pharmacological intervention are available for RLS, including drugs used to treat Parkinson's disease (L-Dopa and dopaminergic agonists), epilepsy (anticonvulsants), anxiety (benzodiazepines), and pain (opioids). Dopaminergic drugs are those most frequently used for treatment of RLS, but some patients do not respond effectively and require other medication. Opioids, a class of medications used to treat severe pain, seem to be effective in treating RLS symptoms, and are recommended for patients with severe symptoms, because RLS and pain appear to share the same mechanismin the central nervous system. All available drugs are associated to some degree with side effects, which can impede treatment. Opioids are associated with adverse events such as constipation, tolerance, and dependence. This justifies the conduct of a systematic review to ascertain whether opioids are safe and effective for treatment of RLS. Objectives To asses the effects of opioids compared to placebo treatment for restless legs syndrome in adults. Search methods We searched the Cochrane Central Register of Controlled trials, CENTRAL 2016, issue 4 and MEDLINE, EMBASE, and LILACS up to April 2016, using a search strategy adapted by Cochraneto identify randomised clinical trials. We checked the references of each study and established personal communication with other authors to identify any additional studies. We considered publications in all languages. Selection criteria Randomised controlled clinical trials of opioid treatment in adults with idiopathic RLS. Data collection and analysis Two review authors independently screened articles, independently extracted data into a standard form, and assessed for risk of bias. If necessary, they discussed discrepancies with a third researcher to resolve any doubts. Main results We included one randomised clinical trial (N = 304 randomiseden
dc.description.abstract204 completeden
dc.description.abstract276 analysed) that evaluated opioids (prolonged release oxycodone/naloxone) versus placebo. After 12 weeks, RSL symptoms had improved more in the drug group than in the placebo group (using the IRLSSS: MD -7.0en
dc.description.abstract95% CI -9.69 to -4.31 and the CGI: MD -1.11en
dc.description.abstract95% CI -1.49 to -0.73). More patients in the drug group than in the placebo group were drug responders (using the IRLSSS: RR 1.82en
dc.description.abstract95% CI 1.37 to 2.42 and the CGI: RR1.92en
dc.description.abstract95% ICI 1.49 to 2.48). The proportion of remitters was greater in the drug group than in the placebo group (using the IRLSSS: RR 2.14en
dc.description.abstract95% CI 1.45 to 3.16). Quality of life scores also improved more in the drug group than in the placebo group (MD -0.73en
dc.description.abstract95% CI -1.1 to -0.36). Quality of sleep was improved more in the drug group measured by sleep adequacy (MD -0.74en
dc.description.abstract95% CI -1.15 to 0.33), and sleep quantity (MD 0.89en
dc.description.abstract95% CI 0.52 to 1.26). There was no difference between groups for daytime somnolence, trouble staying awake during the day, or naps during the day. More adverse events were reported in the drug group (RR 1.22en
dc.description.abstract95% CI 1.07 to 1.39). The major adverse events were gastrointestinal problems, fatigue, and headache. Authors' conclusions Opioids seem to be effective for treating RLS symptoms, but there are no definitive data regarding the important problem of safety. This conclusion is based on only one study with a high dropout rate (moderate quality evidence).en
dc.description.affiliationDepartment of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationDepartment of Morphology, Universidade Federal do Maranhão,São Luis, Brazil
dc.description.affiliationUnifespDepartment of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazi
dc.description.sourceWeb of Science
dc.description.sponsorshipEscola Paulista de Medicina, Universidade Federal de Sao Paulo, Brazil
dc.description.sponsorshipCAPES
dc.description.sponsorshipCNPq, Brazil
dc.format.extentCD006941
dc.identifierhttp://dx.doi.org/10.1002/14651858.CD006941.pub2
dc.identifier.citationCochrane Database Of Systematic Reviews. Hoboken, n. 6, p. CD006941, 2016.
dc.identifier.doi10.1002/14651858.CD006941.pub2
dc.identifier.issn1469-493X
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/49420
dc.identifier.wosWOS:000381106800016
dc.language.isoeng
dc.publisherInst Brasileiro Pesquisa & Ensino Fisiologia Exercicio-Ibpefex
dc.relation.ispartofCochrane Database Of Systematic Reviews
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectLimb Movement-Disorderen
dc.subjectEkbom Diseaseen
dc.subjectDouble-Blinden
dc.subjectSleepen
dc.subjectPrevalenceen
dc.subjectIronen
dc.subjectEpidemiologyen
dc.subjectValidationen
dc.subjectDopamineen
dc.subjectPlaceboen
dc.titleOpioids for restless legs syndromeen
dc.typeinfo:eu-repo/semantics/review
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