Opioids for restless legs syndrome

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dc.contributor.author de Oliveira, Cesar Osorio [UNIFESP]
dc.contributor.author Carvalho, Luciane Bizari Coin [UNIFESP]
dc.contributor.author Carlos, Karla
dc.contributor.author Conti, Cristiane Fiquene
dc.contributor.author de Oliveira, Marcio Moysés
dc.contributor.author Prado, Lucila Bizari Fernandes.
dc.contributor.author Prado, Gilmar Fernandes [UNIFESP]
dc.date.accessioned 2019-01-21T10:29:50Z
dc.date.available 2019-01-21T10:29:50Z
dc.date.issued 2016
dc.identifier http://dx.doi.org/10.1002/14651858.CD006941.pub2
dc.identifier.citation Cochrane Database Of Systematic Reviews. Hoboken, n. 6, p. CD006941, 2016.
dc.identifier.issn 1469-493X
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/49420
dc.description.abstract Background Restless legs syndrome (RLS) is a distressing and common neurological disorder that may have a huge impact in the quality of life of those with frequent and intense symptoms. Patients complain of unpleasant sensations in the legs, at or before bedtime, and feel an urge to move the legs, which improves with movement, such as walking. Symptoms start with the patient at rest (e.g. sitting or lying down), and follow a circadian pattern, increasing during the evening or at night. Many pharmacological intervention are available for RLS, including drugs used to treat Parkinson's disease (L-Dopa and dopaminergic agonists), epilepsy (anticonvulsants), anxiety (benzodiazepines), and pain (opioids). Dopaminergic drugs are those most frequently used for treatment of RLS, but some patients do not respond effectively and require other medication. Opioids, a class of medications used to treat severe pain, seem to be effective in treating RLS symptoms, and are recommended for patients with severe symptoms, because RLS and pain appear to share the same mechanismin the central nervous system. All available drugs are associated to some degree with side effects, which can impede treatment. Opioids are associated with adverse events such as constipation, tolerance, and dependence. This justifies the conduct of a systematic review to ascertain whether opioids are safe and effective for treatment of RLS. Objectives To asses the effects of opioids compared to placebo treatment for restless legs syndrome in adults. Search methods We searched the Cochrane Central Register of Controlled trials, CENTRAL 2016, issue 4 and MEDLINE, EMBASE, and LILACS up to April 2016, using a search strategy adapted by Cochraneto identify randomised clinical trials. We checked the references of each study and established personal communication with other authors to identify any additional studies. We considered publications in all languages. Selection criteria Randomised controlled clinical trials of opioid treatment in adults with idiopathic RLS. Data collection and analysis Two review authors independently screened articles, independently extracted data into a standard form, and assessed for risk of bias. If necessary, they discussed discrepancies with a third researcher to resolve any doubts. Main results We included one randomised clinical trial (N = 304 randomised en
dc.description.abstract 204 completed en
dc.description.abstract 276 analysed) that evaluated opioids (prolonged release oxycodone/naloxone) versus placebo. After 12 weeks, RSL symptoms had improved more in the drug group than in the placebo group (using the IRLSSS: MD -7.0 en
dc.description.abstract 95% CI -9.69 to -4.31 and the CGI: MD -1.11 en
dc.description.abstract 95% CI -1.49 to -0.73). More patients in the drug group than in the placebo group were drug responders (using the IRLSSS: RR 1.82 en
dc.description.abstract 95% CI 1.37 to 2.42 and the CGI: RR1.92 en
dc.description.abstract 95% ICI 1.49 to 2.48). The proportion of remitters was greater in the drug group than in the placebo group (using the IRLSSS: RR 2.14 en
dc.description.abstract 95% CI 1.45 to 3.16). Quality of life scores also improved more in the drug group than in the placebo group (MD -0.73 en
dc.description.abstract 95% CI -1.1 to -0.36). Quality of sleep was improved more in the drug group measured by sleep adequacy (MD -0.74 en
dc.description.abstract 95% CI -1.15 to 0.33), and sleep quantity (MD 0.89 en
dc.description.abstract 95% CI 0.52 to 1.26). There was no difference between groups for daytime somnolence, trouble staying awake during the day, or naps during the day. More adverse events were reported in the drug group (RR 1.22 en
dc.description.abstract 95% CI 1.07 to 1.39). The major adverse events were gastrointestinal problems, fatigue, and headache. Authors' conclusions Opioids seem to be effective for treating RLS symptoms, but there are no definitive data regarding the important problem of safety. This conclusion is based on only one study with a high dropout rate (moderate quality evidence). en
dc.description.sponsorship Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Brazil
dc.description.sponsorship CAPES
dc.description.sponsorship CNPq, Brazil
dc.format.extent CD006941
dc.language.iso eng
dc.publisher Inst Brasileiro Pesquisa & Ensino Fisiologia Exercicio-Ibpefex
dc.relation.ispartof Cochrane Database Of Systematic Reviews
dc.rights Acesso aberto
dc.subject Limb Movement-Disorder en
dc.subject Ekbom Disease en
dc.subject Double-Blind en
dc.subject Sleep en
dc.subject Prevalence en
dc.subject Iron en
dc.subject Epidemiology en
dc.subject Validation en
dc.subject Dopamine en
dc.subject Placebo en
dc.title Opioids for restless legs syndrome en
dc.type Revisão
dc.description.affiliation Department of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliation Department of Morphology, Universidade Federal do Maranhão,São Luis, Brazil
dc.description.affiliationUnifesp Department of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazi
dc.identifier.doi 10.1002/14651858.CD006941.pub2
dc.description.source Web of Science
dc.identifier.wos WOS:000381106800016


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