Aktuelle Neurologie 2011; 38(09): 476-480
DOI: 10.1055/s-0031-1298813
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Unzureichende Behandlung des idiopathischen Restless-Legs-Syndroms? – Ergebnisse einer Patientenbefragung

Symptoms and Treatment of Restless Legs Syndrome – A Patient Survey
H. Beneš
1   Somni Bene – Institut für Medizinische Forschung und Schlafmedizin Schwerin GmbH und Schlaflabor Schwerin
,
N. Reketat
2   UCB Pharma GmbH, Monheim
,
R. Berkels
2   UCB Pharma GmbH, Monheim
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2012 (online)

Zusammenfassung

Fragestellung: Geschätzte 1,3 % der adulten deutschen Bevölkerung leiden unter einem klinisch relevanten, therapiebedürftigen Restless-Legs-Syndrom (RLS). Die vorliegende Patientenbefragung wurde durchgeführt, um Erkenntnisse über die tageszeitliche RLS-Symptomatik und Art und Wirksamkeit der medikamentösen Behandlung aus Patientensicht zu erhalten.

Methodik: Die Mitglieder der Deutschen Restless Legs Vereinigung e. V. und adulte Patienten mit idiopathischem RLS in neurologischen Praxen erhielten Fragebögen zur schriftlichen anonymen Beantwortung.

Ergebnisse: Insgesamt 741 Erhebungsbögen konnten statistisch ausgewertet werden. Die mediane Behandlungsdauer der Befragten (Altersmedian 69 Jahre, 72 % Frauen) betrug 6 Jahre. Von den 651 Patienten mit Angaben zur medikamentösen Behandlung erhielten 70 % Dopaminagonisten und 48 % Levodopapräparate; 40,7 % (Angaben für n = 646) der Patienten erhielten Kombinationstherapien aus unterschiedlichen Medikamentenklassen. Bei 69 % der Patienten traten tagsüber Beschwerden auf und Medikamente wurden bereits morgens (27 %), mittags (25 %) und nachmittags (24 %) eingenommen. Obwohl 80 % der Befragten eine Verbesserung ihrer Lebensqualität durch RLS-Medikation angaben, hielten 70 % ihre derzeitige Therapie für nicht ausreichend.

Schlussfolgerung: Es besteht weiterhin großer Bedarf an einer Verbesserung der medikamentösen RLS-Therapie. Der hohe Anteil an Patienten mit Symptombeginn bereits am Tag weist darauf hin, dass vielfach eine langwirksame medikamentöse Symptomkontrolle erforderlich ist.

Abstract

Objective: Approximately 1.3 % of the adult German population require treatment for a clinically relevant restless legs syndrome (RLS). The present survey was carried out to gain information about the patients’ perspective on the occurrence of symptoms, and the type and effectiveness of pharmacological treatments.

Methods: Members of the German Restless Legs Association and adult patients presenting with idiopathic RLS in neurological practices were given questionnaires for written, anonymous completion.

Results: A total of 741 questionnaires was available for statistical analysis. Median treatment duration of the participants (median 69 years of age, 72 % female) was 6 years. Of the 651 patients with pharmacotherapy data, 70 % received dopamine agonists and 48 % levodopa preparations; 40.7 % (data for n = 646) of the patients received combination therapy using different medication classes. Daytime symptoms occurred in 69 % of the patients, and medication was already administered in the morning (27 %), at noon (25 %) and in the afternoon (24 %). Although 80 % of the participants stated an improvement in quality of life owing to RLS medication, 70 % regarded their current pharmacological therapy as not sufficient.

Conclusion: There are still unmet requirements in RLS pharmacotherapy. The high proportion of patients with daytime symptoms indicates a need for long-acting pharmacological symptom control.

 
  • Literatur

  • 1 García-Borreguero D, Egatz R, Winkelmann J et al. Epidemiology of restless legs syndrome: the current status. Sleep Med Rev 2006; 10: 153-167
  • 2 Allen RP, Walters AS, Montplaisir J et al. Restless legs syndrome prevalence and impact. REST general population study. Arch Intern Med 2005; 165: 1286-1292
  • 3 Nelles S, Köberlein J, Grimm C et al. Sozioökonomische Bedeutung des idiopathischen Restless-Legs-Syndroms (RLS) in Deutschland: Krankheitskostenanalyse. Med Klin 2009; 104: 363-371
  • 4 Allen RP, Picchietti D, Hening WA et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003; 4: 101-119
  • 5 Leitlinien für Diagnostik und Therapie in der Neurologie. http://www.dgn.org/images/stories/dgn/leitlinien/LL2008/ll08kap_006.pdf
  • 6 Hening W, Walters AS, Allen RP et al. Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study. Sleep Med 2004; 5: 237-246
  • 7 Hornyak M, Beneš H, Eisensehr I et al. Depressive Erkrankungen beim Restless-legs-Syndrom. Pathogenese, Diagnose und Implikationen für die Therapie. Nervenarzt 2009; 80: 1160-1168
  • 8 Walters AS, Rye DB. Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep 2009; 32: 589-597
  • 9 Happe S, Reese JP, Stiasny-Kolster K et al. Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med 2009; 10: 295-305
  • 10 Oertel WH, Trenkwalder C, Zucconi M et al. State of the art in restless legs syndrome therapy: practice recommendations for treating restless legs syndrome. Mov Disord 2007; 22 (Suppl. 18) S466-475
  • 11 Trenkwalder C, Hening WA, Montagna P et al. Treatment of restless legs syndrome: an evidence-based review and implications for clinical practice. Mov Disord 2008; 23: 2267-2302
  • 12 Möller C, Wetter TC, Köster J et al. Differential diagnosis of unpleasant sensations in the legs: prevalence of restless legs syndrome in a primary care population. Sleep Med 2010; 11: 161-166
  • 13 García-Borreguero D, Stillman P, Beneš H et al. Algorithms for the diagnosis and treatment of restless legs syndrome in primary care. BMC Neurol 2011; 11: 28
  • 14 Trenkwalder C, Beneš H, Poewe W et al. Efficacy of rotigotine for treatment of moderate-to-severe restless legs syndrome: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2008; 7: 595-604
  • 15 Elshoff JP, Cawello W, Braun M et al. Stable rotigotine plasma concentrations over 24 hours in patients with early-stage Parkinson’s disease after once-daily transdermal administration of rotigotine (Neupro®). Neurology 2006; 66 (Suppl. 02) A293
  • 16 Walters AS, Wagner ML, Hening WA et al. Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo. Sleep 1993; 16: 327-332
  • 17 Walters AS, Winkelmann J, Trenkwalder C et al. Long-term follow-up on restless legs syndrome patients treated with opioids. Mov Disord 2001; 16: 1105-1109
  • 18 Pearson VE, Gamaldo CE, Allen RP et al. Medication use in patients with restless legs syndrome compared with a control population. Eur J Neurol 2008; 15: 16-21
  • 19 García-Borreguero D, Allen RP, Beneš H et al. Augmentation as a treatment complication of restless legs syndrome: concept and management. Mov Disord 2007; 22 (Suppl. 18) S476-S484
  • 20 Högl B, García-Borreguero D, Kohnen R et al. Progressive development of augmentation during long-term treatment with levodopa in restless legs syndrome: results of a prospective multi-center study. J Neurol 2009; 257: 230-237