Withania somnifera as an Adjunctive Treatment for Refractory Restless Legs Syndrome in Parkinson’s Disease: A Case Report

ABSTRACT Restless legs syndrome (RLS) is a disorder commonly found in patients with Parkinson's disease, with descriptions for both conditions impairing dopaminergic transmission in central nervous system. Previous studies in varied populations indicate an association between the presence of RLS and increased cardiovascular risk and, so far, there are no consistent studies of this association in Parkinson's disease. Objective: To analyze the influence of RLS on cardiovascular risk in patients with Parkinson's disease. Methods: We reviewed the medical records of 202 patients diagnosed with Parkinson's disease and verified the presence of RLS, cardiovascular comorbidities, blood pressure measurements, lipid profiles and Framingham Risk Scores. Results: Statistically significant higher values of total cholesterol were found for the RLS group (mean 216.6 mg/dL), as well as for LDL cholesterol (mean 145 mg/dL). No statistical difference was found among the other factors. Conclusion: Patients with Parkinson's disease and RLS have a higher prevalence of dyslipidemia than patients without RLS, suggesting a correlation between restless legs and hyperlipidemia. It is questioned whether the dopaminergic substrate is the main factor in the genesis of the syndrome, as even with the use of dopaminergic agonists by both groups, it was possible to observe differences between groups. The hypothesis of the real interference of the syndrome treatment as a protective factor for cardiovascular risk was generated.

Download Full-text

Restless Legs Syndrome in Parkinson's Disease Patients: Clinical Features Including Motor and Nonmotor Symptoms

Journal of Clinical Neurology ◽

10.3988/jcn.2019.15.3.321 ◽

2019 ◽

Vol 15 (3) ◽

pp. 321 ◽

Cited By ~ 3

Author(s):

Sooyeoun You ◽

Soo Myeong Jeon ◽

So Young Do ◽

Yong Won Cho

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Clinical Features ◽

Restless Legs Syndrome ◽

Nonmotor Symptoms ◽

Restless Legs

Download Full-text

Effective treatment of restless legs syndrome by safinamide in Parkinson's disease patients

Sleep Medicine ◽

10.1016/j.sleep.2017.09.017 ◽

2018 ◽

Vol 41 ◽

pp. 113-114 ◽

Cited By ~ 6

Author(s):

Claudio Liguori ◽

Nicola Biagio Mercuri ◽

Alessandro Stefani ◽

Mariangela Pierantozzi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Effective Treatment ◽

Restless Legs Syndrome ◽

Restless Legs

Download Full-text

An Exploratory Retrospective Evaluation of Ropinirole-Associated Psychotic Symptoms in an Outpatient Population Treated for Restless Legs Syndrome or Parkinson's Disease

Annals of Pharmacotherapy ◽

10.1345/aph.1m183 ◽

2009 ◽

Vol 43 (9) ◽

pp. 1426-1432 ◽

Cited By ~ 10

Author(s):

Steven C Stoner ◽

Megan M Dahmen ◽

Mignon Makos ◽

Jessica W Lea ◽

Lora J Carver ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dopamine Receptors ◽

Restless Legs Syndrome ◽

Dopamine Agonists ◽

Dual Therapy ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Restless Legs ◽

Psychotic Features

Background: Traditional treatment approaches for the management of restless legs syndrome (RLS) and Parkinson's disease (PD) include the use of medications that either directly or indirectly increase dopamine levels. In turn, a potential adverse event that could be expected is the development or exacerbation of psychiatric-related symptoms. Objective: To evaluate and describe the incidence of psychosis and associated behavioral features in patients taking ropinirole for RLS or PD. Methods: Patients were identified from a computerized database search of outpatients being treated with ropinirole for 1 of 2 medical conditions: PD or RLS. Data were collected in a retrospective manner from 95 patients who were tracked over the course of their therapy to determine whether psychosis or associated behavioral symptoms developed as a result and whether an intervention was needed to adjust ropinirole dosing or if additional medications had to be added to control features associated with psychosis. Results: A total of 284 patients being treated for RLS or PD were identified; of this group, 95 patients were identified as being treated for PD or RLS with ropinirole. Of the 95 patients being treated with ropinirole, 13 developed psychotic features that required therapeutic intervention with either the use of an antipsychotic or dose adjustment of ropinirole. PD patients included in this study were numerically more likely to develop psychotic features compared with RLS patients; however, the difference was not statistically significant (p = 0.122). The results do suggest that this risk is increased when ropinirole is used as part of a dual therapy approach with dopamine agonists in the treatment of either PD or RLS (p = 0.003). Discussion: Dopamine agonists have long been used as preferred treatment in the management of PD and RLS. When treating either PD or RLS in the psychiatric population, the concern arises that increased activity at dopamine receptors may induce or exacerbate psychiatric features. A potential clinical concern with the use of ropinirole is the potential for patients to develop psychiatric features, although there are few data available to demonstrate whether stimulation of targeted individual dopamine receptors is linked to the development or exacerbation of psychotic features. It is also undetermined whether concurrent antipsychotic treatment provides any protective benefit against psychosis, especially in patients already being treated for psychotic symptoms. Conclusions: Our findings suggest that ropinirole may play a role in inducing or exacerbating psychosis and its associated features, although a number of confounding variables prevent the determination of a clear association and suggest that further investigation is warranted in controlled clinical trials.

Download Full-text