Newsgroup: it.scienza.medicina
Titolo: Sindrome delle gambe senza riposo

Paziente di 78 anni con diagnosi di "sindrome delle gambe senza riposo".
Lamenta disestesie urenti alle gambe prevalentemente notturne.
Qualcuno può suggerirmi quali possibilità di cura?
Grazie!
Fisiatra alle prime armi.

Ho sentito che i neurologi stanno utilizzando il gabapentin, ma non so con
quali risultati.
Ciao

 Grazie!
Un paio di mesi fa è uscita una clinical practice sul New England Journal of
Medicine a riguardo della Restless Leg Syndrome. Confermo che spesso viene
usato il gabapentin... ma mi informerò meglio rileggendo appena possibile
quell'articolo!
Saluti
--
____________________________________
Doctor Phil

 ha scritto nel messaggio
news:_rLWa.220979$Ny5.6...@twister2.libero.it...

E' stato verificato che il paziente non soffra di squilibri
elettrolitici?
Magnesio, potassio, calcio?
Magnesio eritrocitario, per la precisione.
Mirco

 Lamenta disestesie urenti alle gambe prevalentemente notturne.
domanda: il medico (immagino neurologo) che l'ha diagnosticata non ha
prescritto una terapia?
in genere che io sappia si usa da diverso tempo il pramipexolo;  ho letto
che si usa anche il gabapentin, nei pz in cui i sintomi dolorosi sono più
invalidanti rispetto all'irrequietezza motoria.
ma giustamente vanno escluse prima altre possibili cause di restless legs
syndrome (esistono anche le forme secondarie...).
sottolineo che queste terapie vanno prescritte da qualcuno che la malattie
la conosca e ne abbia seguito alcuni casi, e sappia maneggiare questi
farmaci (sempre qualora si confermi la diagnosi ed essa sia corretta),
soprattutto trattandosi di persona anziana (ad esempio non si può partire
con dosi alte di gabapentin, si può aumentare il rischio di cadute
accidentali, non mi sembra proprio il caso).
Riporto cmq una review recente e un articolo che espone i risultati uno
studio in doppio cieco per il gabapentin:
-----------------------------------------
      Drugs Aging. 2002;19(10):741-51.
Restless legs syndrome in the older adult: diagnosis and management.
Milligan SA, Chesson AL.
Department of Medicine, Veterans Administration Medical Center and Louisiana
State University Health Sciences Center, Shreveport, Louisiana 71130, USA.
Restless legs syndrome (RLS) is common in the elderly, with an estimated
prevalence of 10 to 35% in individuals over 65 years of age. RLS is
characterised by paraesthesias and dysaesthesias of the legs, typically
occurring in the evening. The symptoms occur at rest and result in motor
restlessness; movement often temporarily relieves the symptoms. Patients
with poorly controlled RLS may develop related problems including insomnia
(due to sleep-onset restlessness or periodic limb movements or related sleep
fragmentation) and depression. RLS can be a primary disorder that develops
in the young and includes familial cases. Secondary RLS occurs in
association with iron-deficiency anaemia, uraemia and polyneuropathies.
Typically, RLS is misdiagnosed or undiagnosed for years. In the elderly,
both primary and secondary types of the disorder are common. It is thought
that RLS represents lower CNS levels of, or reduced responsiveness to,
dopamine. The symptoms improve with dopaminergic therapy. Ergotamine
dopamine-receptor agonists such as pergolide, and the non-ergotamine
dopamine-receptor agonists pramipexole and ropinirole, are becoming more
commonly used to treat RLS. The dopamine precursor levodopa, in combination
with carbidopa, is another effective therapeutic agent. An advantage of
levodopa is lower cost than non-ergotamine and ergotamine dopamine-receptor
agonists. However, the adverse effect of symptom augmentation appears to
develop more frequently with levodopa than dopamine-receptor agonists;
therefore, levodopa may currently be used somewhat less often as first-line
therapy. Patients with painful symptoms may respond favourably to the
anticonvulsants gabapentin and carbamazepine. Opioids and hypnosedatives are
helpful in selected patients; however, these agents may have troubling
adverse effects in the elderly. Correction of iron deficiency improves
symptoms in patients with low ferritin levels. Lifestyle modification may
also be helpful. Therapy is directed at symptoms, and most symptomatic
patients benefit from treatment. It is important to consider RLS in the
differential diagnosis of any patient with paraesthesias of the limbs.
-------------------------------------
      Neurology. 2002 Nov 26;59(10):1573-9.
Comment in:
  a.. ACP J Club. 2003 Jul-Aug;139(1):17.
Treatment of restless legs syndrome with gabapentin: a double-blind,
cross-over study.
Garcia-Borreguero D, Larrosa O, de la Llave Y, Verger K, Masramon X,
Hernandez G.
Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain.
dgarciab...@fjd.es
OBJECTIVE: To assess the effects of gabapentin on sensory and motor symptoms
in patients with restless legs syndrome (RLS). METHODS: Patients with RLS
(22 idiopathic, 2 secondary to iron deficiency) were randomized and treated
for 6 weeks with either gabapentin or placebo. After a 1-week washout they
crossed over to the alternative treatment for 6 weeks. Patients were rated
at baseline and at scheduled intervals by the RLS Rating Scale, Clinical
Global Impression, pain analogue scale, and Pittsburgh Sleep Quality Index.
At the end of each treatment period, all-night polysomnography was
performed. RESULTS: Compared to placebo, gabapentin was associated with
reduced symptoms on all rating scales. In addition, sleep studies showed a
significantly reduced periodic leg movements during sleep (PLMS) index and
improved sleep architecture (increased total sleep time, sleep efficiency,
and slow wave sleep, and decreased stage 1 sleep). Patients whose symptoms
included pain benefited most from gabapentin. The mean effective dosage at
the end of the 6-week treatment period was 1,855 mg, although therapeutic
effects were already observed at the end of week 4 (1,391 mg). CONCLUSIONS:
Gabapentin improves sensory and motor symptoms in RLS and also improves
sleep architecture and PLMS.
--
saluti,
Laura


A titolo puramente accademico, anche perché la ketamina non si trova dietro
l'angolo...
Cmq dovrebbe essere efficace soprattutto sui dolori e le disestesie.
Anesth Analg. 2002 Jun;94(6):1558-9, table of contents.
Comment in:    Anesth Analg. 2003 Apr;96(4):1238; author reply 1238-9.Oral
ketamine: a promising treatment for restless legs syndrome.Kapur N, Friedman
R.Department of Anesthesiology, Temple University Hospital, Philadelphia,
Pennsylvania, USA.IMPLICATIONS: Oral Ketamine, an NMDA receptor antagonist,
can be used to treat restless legs syndrome. A mechanism for the efficacy of
this treatment is discussed.PMID: 12032026 [PubMed - indexed for MEDLINE]

Ho sentito parlare del neurontin a basso dosaggio, un farmaco che si usa
anche per altre malattie neurologiche