BERLIN — Patients along with restless legs syndrome (RLS) for whom conventional therapies are contraindicated might reward from a treatment usually reserved for patients along with advanced Parkinson’s ailment and augmentation phenomena, a case report suggests.
In a presentation below at the 20th Worldwide Conference of Parkinson’s ailment and Movement Disorders, Jesús Pérez-Pérez, MD, of the Movement Disorders Unit at the Hospital de la Santa Creu i Sant Pau, in Barcelona, Spain, described the case of a 70-year-old man that had endured RLS along with augmentation for 3 years. The patient was successfully treated using a 24-hr infusion of carbidopa/levodopa enteral gel (Duopa, AbbVie Inc).
His condition had initially responded well to dopaminergic medication, however after 1 year of therapy along with dopaminergic drugs, augmentation began, and RLS was present all of day and was even worse at night. Augmentation is a phenomenon of worsening symptoms after dopaminergic drug exposure.
The patient had severe, chronic obstructive pulmonary ailment and had undergone several hospitalizations in much less compared to a year due to respiratory decompensation. For these reasons, drugs such as benzodiazepines, opioids, gabapentin (multiple brands), and pregabalin (Lyrica, PF Prism CV) were contraindicated. due to RLS, the patient was unable to usage nocturnal continuous positive airway pressure, which led to hypercapnic respiratory failure.
The treating physicians after that offered, and the patient accepted, 24-hr constant infusion along with carbidopa/levodopa enteral gel delivered by pump straight in to the small intestine through a tube along with a jejunal extension introduced percutaneously in to the stomach. due to the continuous drug delivery, this system avoids the pulsatile dosing effect that leads to augmentation.
Three months after starting therapy along with the enteral gel formulation, the patient’s RLS symptoms were greatly improved, as was his quality of life, Dr Pérez-Pérez reported.
Table. Outcomes of Switching Patient From Oral to Enteral Infusion Medication
| Intervention/Period | RLS Rating Scale Score | RLS Quality-of-Life Questionnaire |
| Oral/preintervention* | 36 (pretty severe) | 22 |
| Enteric gel at 3 months | 9 (mild) | 74 |
| Enteric gel at 1 year | 4 (mild) | 100 |
|
*Levodopa/carbidopa 150 mg 5x/day plus levodopa/carbidopa retard 200 mg at night. |
||
Symptoms and quality-of-life scores continued to boost throughout the very first year of treatment, as reflected in Clinical Global Impression–Improvement scale scores.
The patient has actually not endured any sort of edge effects or complications from the medication or the implantation procedure and was hospitalized just when throughout the year.
Olga Klepitskaya, MD, associate professor of neurology at the University of Colorado, in Denver, that has actually a special interest in the usage of deep brain stimulation to address RLS, commented to Medscape Medical News that despite the fact that the presentation involved a single case report, it was well done and is important. “They described pretty well why they did [it] and just what they did and just what are the implications of that,” she said.
“Simply enjoy in Parkinson’s disease, along with RLS…pulsatile dopaminergic stimulation is not healthy and balanced for our dopamine receptors in the brain, and that’s why it induces all of these troubles of augmentation,” she said. The mainstream treatment of augmentation is to usage longer-acting dopaminergic medications, such as rotigotine transdermal patches (Neupro, UCB Pharma, Inc), longer-acting pramipexole (Miraprex ER, Boehringer Ingelheim Pharmaceuticals, Inc), and ropinirole (Requip XL, GlaxoSmithKline).
The treatments that offer constant dopaminergic stimulation are much better physiologically for the brain, “and Duopa is the utmost long-acting medication,” she said. “It’s administered through the GI system, and I assume it can easily be used for very, pretty serious RLS along with augmentation that cannot be treated by anything else.”
Calling delivery of the medication through a percutaneous indwelling tube “a little bit extreme,” she said the authors “actually justified why they used this…for this particular patient, since he had a great deal of comorbidities that can easily [lead to] a great deal of adverse effects.”
For this patient, the choice of this continuous however somewhat invasive treatment, which led to substantial improvement in quality of life, appeared correct, she said.
Dr Klepitskaya said she believes that treatments that offer continuous stimulation ― whether pharmacologic or electrical ― would certainly be best.
“That’s why I have actually position my hopes in my study, deep brain stimulation for RLS,” she said, “and deep brain stimulation and Duopa now can easily be not permanently interchangeable, however we are curious about the two as treatments available in the United States in patients along with pretty advanced Parkinson’s ailment and attempting to discover which of those treatments will certainly suit that particular patient profile the best.”
The current case report and others reports on the usage of deep brain stimulation suggest that difficult-to-address RLS could be amendable to these treatments as well.
Dr Pérez-Pérez and Dr Klepitskaya have actually disclsoed no relevant financial relationships.
20th Worldwide Conference of Parkinson’s ailment and Movement Disorders: Abstract 953. Presented June 21, 2016.