Efficacy Study Of Restless Leg Syndrome Medication-Pramipexole

Definition

Restless legs syndrome is a sensory-motor disorder of the nervous system, which is characterized by indescribable discomfort in the lower limbs during sleep or resting state, which can only be relieved by beating the legs or getting out of bed. There is an obvious circadian rhythm pattern, and the nighttime is the most important. The patient is difficult to fall asleep, which seriously affects the quality of life. Most of the patients are treated with sleep disorders. The disease is dominated by subjective symptoms and few objective signs. The diagnosis is mainly based on clinical manifestations, so it is easy to be missed and misdiagnosed, and the treatment methods are limited.

Classification

Restless legs syndrome is divided into two main categories, primary and secondary. Most of the primary is related to genetic factors, about 55% to 90% of primary restless legs syndrome have a positive family history, showing an autosomal dominant inheritance; there are many secondary reasons, such as iron deficiency, uremia, Diabetes, pregnancy, peripheral neuropathy, and certain medications (eg, long-term use of diphenhydramine, phenothiazines, lithium, and tricyclic antidepressants).

Pathogenesis

The pathogenesis of restless legs syndrome is still not very clear. It is currently believed that genetic factors, abnormal dopamine function in the central system, abnormal iron metabolism, and spinal cord conduction pathway lesions are related to the pathogenesis, and abnormal dopamine function plays a key role in the pathogenesis. The dopaminergic content of the nigrostriatum and mesolimbic system is related to restless legs syndrome. Studies have confirmed that the patient is not caused by the nigrostriatal dopamine pathway, but other parts of the pathway. Iron is a cofactor for the rate-limiting enzyme tyrosine hydroxylase in dopamine synthesis, and iron deficiency reduces dopamine synthesis. Spinal cord conduction pathway lesions are mainly due to decreased dopamine resulting in decreased spinal cord inhibitory impulses, and increased sensitivity of flexor reflexes resulting in restless legs syndrome. Therefore, the use of restless leg syndrome medications such as levodopa and dopamine agonists can significantly relieve symptoms.

The treatment of restless legs syndrome is divided into non-drug and drug therapy.

Drug therapy

According to the pathogenesis and a large number of clinical trials, dopaminergic drugs are the first-line restless leg syndrome medications. The earliest clinical application is levodopa, which is one of the class of short-acting restless leg syndrome medications. Its adverse reactions during application are anorexia, nausea, vomiting, loss of appetite, abdominal discomfort, flatulence, dry mouth, dysphagia, salivation, burning tongue, bitter mouth, diarrhea or constipation, etc., which make peptic ulcer worse , causing bleeding. With the prolongation of medication time, the incidence of adverse reactions in the gastrointestinal tract decreases, but some people still cannot tolerate the effective dose, which limits the clinical application. The dopamine receptor agonist pramipexole is a D3 receptor agonist with high bioavailability, greater than 90%, not affected by food, taking it with food does not reduce its absorption, oral absorption is rapid and complete, and the blood concentration reaches a peak within 2 hours of taking the drug . Some clinical studies have shown that starting from a small dose and gradually increasing the dose, pramipexole can significantly improve the symptoms of restlessness in the lower limbs of patients, shorten the time for patients to fall asleep, increase the total sleep time, improve the quality of sleep, and the treatment effect is good. Pramoxo is effective at low dose, with a daily dose from 0.25mg to 0.75mg, which is significantly less than the dose for Parkinson's disease. Pramoxo is well tolerated in patients with restless leg syndrome, with minor adverse reactions, and no special treatment or termination of treatment is required. So pramipexole is a very effective restless leg syndrome medication.

Non-drug therapy

Avoid caffeine, nicotine, and alcohol, especially in the hours before bed.

Schedule activities that require reclining, such as sedentary or car and air travel, as well as appointments to see a doctor, preferably in the morning, preferably not in the afternoon.

Doing soothing leg stretches before bedtime, rubbing your leg muscles, taking a shower, or using a heating pad can prevent nighttime cramps from causing muscle damage or overexertion.

Summary

In conclusion, restless legs syndrome is a common clinical disease, and patients often seek medical attention due to sleep disorders. Low-dose dopamine receptor agonist pramipexole, as a restless leg syndrome medication, can significantly improve sleep quality, reduce the severity of symptoms, and improve quality of life.