ergoline and Restless-Legs-Syndrome

Restless legs syndrome (RLS) is a common neurological disorder that might impair nocturnal rest causing decreased alertness, depressed mood, reduced job performance, and poor quality of life. In patients affected by severe RLS, a pharmacological treatment is mandatory.. The present review is based on a search using PubMed from 1994 to 2012. It is focused on the Absorption, Distribution, Metabolism, Elimination and Toxicology (ADMET) characteristics of the most used medications for RLS. In particular, the ADMET characteristics of dopaminergic agents, anticonvulsants able to improve neuropathic pain, and iron were discussed.. Clinical trials have showed that non-ergolic dopamine agonists are efficacious and safe for patients affected by moderate to severe idiopathic RLS. However, no head-to-head study has compared the long-term effects of the three dopamine agonists approved by the FDA for RLS (ropinirole, pramipexole, and rotigotine). Moreover, further studies should investigate the extended-release formulation of ropinirole and pramipexole in RLS patients affected by all day long distressing symptoms. A standardized treatment for symptomatic forms of RLS is lacking. Randomized, placebo-controlled trials should be performed at least in RLS patients with peripheral neuropathic and chronic kidney disease. Concerning RLS due to iron deficiency, a head-to-head study comparing efficacy, safety and compliance of oral iron versus intravenous one seems to be needed.

Topics: Amines; Anticonvulsants; Benzothiazoles; Carbamates; Cyclohexanecarboxylic Acids; Dopamine Agents; Dopamine Agonists; Ergolines; Gabapentin; gamma-Aminobutyric Acid; Humans; Indoles; Levodopa; Neuralgia; Pramipexole; Pregabalin; Randomized Controlled Trials as Topic; Restless Legs Syndrome; Tetrahydronaphthalenes; Thiophenes; Treatment Outcome

A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS.

Topics: Academies and Institutes; Benzothiazoles; Cabergoline; Carbamates; Dopamine Agents; Ergolines; Evidence-Based Medicine; gamma-Aminobutyric Acid; Humans; Indoles; Levodopa; Nocturnal Myoclonus Syndrome; Pergolide; Peripheral Nervous System Diseases; Pramipexole; Restless Legs Syndrome; Sleep Medicine Specialty; United States; Venous Insufficiency

According to clinical guidelines, dopamine agonists are the first-line treatment of restless legs syndrome (RLS).. To evaluate efficacy and safety of dopamine agonists for RLS.. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE, EMBASE, PsycINFO and CINAHL, from January 1985 to December 2008, plus reference lists of articles. We contacted pharmaceutical companies.. We included double-blind randomised controlled trials (RCTs) of dopamine agonist treatment versus placebo or other treatment for a period of at least seven days in patients with RLS (≥ 18 years). Outcomes included the International RLS Severity Rating Scale (IRLS), Clinical Global Impressions (CGI-I), polysomnography and self rated sleep quality, quality of life, daytime functioning, and safety parameters.. Two reviewers extracted data separately; assessed risk of bias; and contacted pharmaceutical companies and authors for additional information. We collected dropout rates due to adverse events and experience of adverse events.. We included 35 placebo controlled and three active controlled RCTs (N = 7365). The mean reduction on the IRLS was -5.7 points lower in dopamine agonist treatment compared to placebo (95% confidence interval (CI) -6.7 to -4.7). Periodic limb movements in sleep per hour of sleep (PLMS-Index; PLMSI) were -22.4/h lower than in placebo (95% CI -27.8 to -16.9). Self rated quality of sleep and disease specific quality of life were improved by a standardised mean difference (SMD) of 0.40 (95% CI 0.33 to 0.47) and 0.34 (95% CI 0.23 to 0.44), respectively. Patients were more likely to drop out (odds ratio (OR) 1.82, 95% CI 1.35 to 2.45) and experienced more adverse events under dopamine agonist treatment than with placebo (OR 1.82, 95% CI 1.59 to 2.08). Visual inspection of forest plots showed the highest efficacy in three studies investigating cabergoline and pergolide (N = 3). Active controlled trials investigated effects of cabergoline, pergolide, and pramipexole in a number of outcomes. The IRLS score was lower with cabergoline and pramipexole compared to levodopa (MD -5.3, 95% CI -8.4 to -2.1). Only four studies investigated treatment efficacy up to seven months. The most severe side effect, augmentation, was not assessed reliably.. The meta-analyses show the superiority of dopamine agonists over placebo in RCTs up to seven months. Cabergoline and pramipexole showed larger efficacy compared to levodopa in some but not all outcomes.

Topics: Benzothiazoles; Cabergoline; Dopamine Agonists; Ergolines; Humans; Levodopa; Pergolide; Pramipexole; Randomized Controlled Trials as Topic; Restless Legs Syndrome; Severity of Illness Index

Restless legs syndrome (RLS) is a common neurological disorder characterized by an urge to move the legs. The symptoms show a strong circadian rhythmicity, with onset or increase in the evening or at night; thus, sleep disturbances are the most frequent reason for patients seeking medical aid. The prevalence of the disorder increases strongly with age, with an estimated 9% to 20% of sufferers being among the elderly. Dopaminergic drugs are the first-line treatment option in RLS; opioids and anticonvulsants can also be used either as add-on or stand alone therapy options. Secondary forms of RLS and possible interaction with other medications require particular consideration in the elderly.

Topics: Aged, 80 and over; Benzothiazoles; Cabergoline; Circadian Rhythm; Cognition Disorders; Comorbidity; Diagnosis, Differential; Dopamine Agonists; Ergolines; Humans; Indoles; Polysomnography; Pramipexole; Prevalence; Restless Legs Syndrome; Sleep Wake Disorders

Augmentation is a major problem with dopaminergic therapy for restless legs syndrome (RLS), and predictors of augmentation have not yet been identified. We aimed to analyze the relationship between baseline ferritin level and occurrence of augmentation in a retrospective analysis of a prospective double-blind trial of cabergoline versus levodopa on augmentation in RLS.. Patients who experienced augmentation were compared to patients who did not experience augmentation.. Augmentation symptoms causing premature discontinuation from the study or which were tolerated (n=36, ferritin: 85+59 ng/ml) were associated with lower levels of serum ferritin compared to patients without augmentation (n=302, ferritin: 118+108 ng/ml, p=0.0062).. Ferritin as a marker of iron storage may play an important role in the pathophysiology of RLS and may prove to be a biomarker for the development of augmentation under dopaminergic therapy.

Topics: Adult; Cabergoline; Dopamine Agonists; Double-Blind Method; Ergolines; Female; Ferritins; Humans; Levodopa; Male; Patient Dropouts; Prospective Studies; Restless Legs Syndrome; Retrospective Studies; Risk Factors

We report the first large-scale double-blind, randomly assigned study to compare two active dopaminergic therapies for Restless Legs Syndrome (RLS), the dopamine agonist cabergoline (CAB) and levodopa/benserazide (levodopa). Patients with idiopathic RLS were treated with fixed daily doses of 2 or 3 mg CAB or 200 or 300 mg levodopa for 30 weeks. Efficacy was assessed by changes in the IRLS (International RLS Severity Scale) and by time to discontinuation of treatment due to loss of efficacy or augmentation. 361 of 418 screened patients (age 58 +/- 12 years, 71% females) were randomly assigned and treated (CAB: n = 178; levodopa: n = 183) in 51 centers of four European countries. Baseline IRLS total score was 25.7 +/- 6.8. The baseline-adjusted mean change from baseline to week 6 in IRLS sum score was d = -16.1 in the CAB group and d = -9.5 in the levodopa group (d = -6.6, P < 0.0001). More patients in the levodopa group (24.0%) than in the CAB group (11.9%, P = 0.0029, log-rank test) discontinued because of loss of efficacy (14.2% vs. 7.9%, P = 0.0290) or augmentation (9.8% vs. 4.0%, P = 0.0412). Adverse events (AEs) occurred in 83.1% of the CAB group and in 77.6% of the levodopa group. In both groups, most frequent AEs were gastrointestinal symptoms (CAB: 55.6%, levodopa: 30.6%, P < 0.0001). This first large-scale active controlled study in RLS showed superior efficacy of cabergoline versus levodopa after a 30-week long-term therapy. Tolerability was found more favorable with levodopa than with cabergoline.

Topics: Adult; Aged; Antiparkinson Agents; Cabergoline; Dopamine Agonists; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Ergolines; Europe; Female; Humans; Levodopa; Male; Middle Aged; Neurologic Examination; Restless Legs Syndrome

To investigate whether the increased urge to move the legs in restless legs syndrome (RLS) corresponds to an electrophysiological phenomenon and whether motor excitability or behavior is influenced by the treatment with a dopamine agonist. We examined 10 patients who had RLS with transcranial magnetic stimulation (TMS) before and during treatment with the dopamine agonist cabergoline. Results were compared with data obtained from healthy subjects. Inhibitory mechanisms were explored by measurement of the cortical silent period (cSP). Recordings were obtained from the right anterior tibial muscle. Clinical severity of RLS was rated using the International Restless Legs Syndrome Study Group Rating Scale (IRLSSGRS). During therapy with cabergoline, all patients reported a significant improvement of RLS symptoms. Before medication, patients showed a significant shortening of cSP compared with healthy subjects. After 14 days of treatment with cabergoline, cSP normalized in RLS patients; 90 days after the start of daily cabergoline, cSP tended to shorten again, whereas RLS symptoms further improved. There was no correlation between cSP duration and IRLSSGRS results. There were no differences in patient and control motor thresholds. These thresholds remained unchanged during treatment with cabergoline. RLS patients have a disturbance of inhibitory neurons that can temporarily be reversed with a dopamine agonist. However, the cSP does not correlate with the clinical symptoms.

Topics: Aged; Cabergoline; Dopamine Agonists; Electromyography; Ergolines; Evoked Potentials, Motor; Humans; Middle Aged; Motor Cortex; Muscle Contraction; Muscle, Skeletal; Neural Inhibition; Restless Legs Syndrome; Sensory Thresholds; Severity of Illness Index; Time Factors; Transcranial Magnetic Stimulation; Treatment Outcome

To determine the effective dose of cabergoline in Japanese patients with restless legs syndrome (RLS).. Six cases of idiopathic RLS and three of RLS with Parkinson disease (PD) participated in an open clinical preliminary trial. All cases were diagnosed based on the clinical criteria of the International RLS Study Group. Three RLS cases (1.3%) were detected out of 229 consecutive cases with PD. RLS severity was evaluated with International RLS Study Group (IRLSSG) Rating Scale Version 2.2 before and one year after the treatment with cabergoline.. For 6 idiopathic RLS patients, the IRLSSG questionnaire scores improved from 25.5+/-3.7 to 10.7+/-8.9 (p=0.028, Wilcoxon test) with 1 mg of daily cabergoline at the endpoint. For 3 RLS cases with PD, the score was 21.7+/-3.7 before the treatment, and RLS symptoms completely disappeared with 1 mg of cabergoline. One of RLS cases with PD required additional cabergoline later because of parkinsonism. No adverse event with cabergoline was reported in this study.. One mg of daily cabergoline is effective in some Japanese patients of RLS.

Topics: Aged; Aged, 80 and over; Cabergoline; Dopamine Agonists; Ergolines; Female; Humans; Male; Middle Aged; Restless Legs Syndrome; Treatment Outcome

To assess the efficacy and safety of the dopamine agonist cabergoline in the treatment of patients with idiopathic restless legs syndrome (CATOR study).. Patients with moderate to severe restless legs syndrome (RLS) were randomly assigned to cabergoline (single evening dose: 2 mg) or placebo and treated for 5 weeks in a double-blind, multicenter polysomnography (PSG) trial. The primary efficacy measures were the periodic leg movements during sleep arousal index (PLMS-AI) and sleep efficiency. These and further PSG variables were monitored by centrally evaluated PSG. Severity of RLS was assessed using the International RLS Study Group Severity Scale (IRLS), the RLS-6 scales, the Sleep Questionnaire Form A (SF-A; quality of sleep), and the Quality of Life for RLS questionnaire.. Forty-three patients were treated and 40 patients were evaluated with PSG (age 56 +/- 10 years, 73% women). Cabergoline was superior to placebo in terms of the PLMS-AI (-17.7 +/- 16.4 vs -4.5 +/- 20.0 placebo; p = 0.0024), sleep efficiency (+6.2 +/- 13.9% vs +3.3 +/- 11.7%; p = 0.0443), PLMS index (p = 0.0014), PLM index (p = 0.0012), and total sleep time (p = 0.0443). Improvements in IRLS total score (-23.7 +/- 11.2 vs -7.9 +/- 11.0 placebo; p = 0.0002), RLS-6 severity scales during the night (p = 0.0010) and during the day (p = 0.0018), Clinical Global Impressions severity item (p = 0.0003), sleep quality (p = 0.0180), SF-A sleep quality (p = 0.0371), and QoL-RLS (p = 0.0247) were larger in patients treated with cabergoline compared with the placebo group. Adverse events were only mild and well-known side effects of dopamine agonists.. Single-evening cabergoline is an efficacious and well-tolerated short-term therapy for sensorimotor symptoms of restless legs syndrome and associated sleep disturbances.

Topics: Adolescent; Adult; Aged; Cabergoline; Case-Control Studies; Dopamine Agonists; Double-Blind Method; Drug Administration Schedule; Ergolines; Female; Humans; Male; Middle Aged; Psychometrics; Restless Legs Syndrome; Severity of Illness Index; Statistics, Nonparametric

To reverse the profile of abnormal intracortical excitability in patients with restless legs syndrome (RLS) by administering the dopaminergic agonist cabergoline.. The effects of this drug on motor cortex excitability were examined with a range of transcranial magnetic stimulation (TMS) protocols before and after administration of cabergoline over a period of 4 weeks in 14 patients with RLS and in 15 healthy volunteers. Measures of cortical excitability included central motor conduction time; resting and active motor threshold to TMS; duration of the cortical silent period; short latency intracortical inhibition (SICI) and intracortical facilitation using a paired-pulse TMS technique.. Short latency intracortical inhibition was significantly reduced in RLS patients compared with the controls and this abnormal profile was reversed by treatment with cabergoline; the other TMS parameters did not differ significantly from the controls and remained unaffected after treatment with cabergoline. Cabergoline had no effect on cortical excitability of the normal subjects.. As dopaminergic drugs are known to increase SICI, our findings suggest that RLS may be caused by a central nervous system dopaminergic dysfunction. This study demonstrates that the cortical hyperexcitability of RLS is reversed by cabergoline, and provides physiological evidence that this dopamine agonist may be a potentially efficacious option for the treatment of RLS.

Topics: Adult; Aged; Brain Diseases; Cabergoline; Dopamine; Dopamine Agonists; Ergolines; Female; Humans; Male; Membrane Potentials; Middle Aged; Motor Cortex; Neural Conduction; Neural Inhibition; Neurons; Pyramidal Tracts; Reaction Time; Restless Legs Syndrome; Synaptic Transmission; Transcranial Magnetic Stimulation; Treatment Outcome

To assess the safety and efficacy of cabergoline in the treatment of idiopathic restless legs syndrome (RLS) patients.. Open-label intervention study for 26 weeks; no control group.. 302 patients (73% women, aged 61 +/- 11 years) from 37 German neurologic outpatient departments and private practices.. Cabergoline was upwardly titrated over 4 weeks to individually optimized dosages. Median treatment duration was 181 days. The median daily dose of cabergoline was 1.5 mg.. Drug safety was assessed by adverse events; efficacy was evaluated with the RLS-6 and the International RLS Rating Scales.. In 48% of the study participants, investigators reported adverse events suspected to be drug related. Most adverse events were mild and transient and related to the gastrointestinal system (nausea: 16.6%) or the central nervous system (dizziness: 7.0%, headache: 4.6%). Premature dropout from the study occurred in 54 patients (17.9%), in 17 patients (3.0%) due to a drug-related adverse event. The severity of RLS symptoms at night, at bedtime, and during the day, as well as the International RLS Rating Scale total score improved during therapy. Satisfaction with sleep was increased (all P values < .001). In 5% of all patients, RLS symptoms worsened, and in a further 6.3%, response to therapy was poor. In 9 patients (3.0%) between 1 and 3 criteria for augmentation were noted.. Long-term therapy with cabergoline is a safe and well-tolerated treatment option for the great majority of patients with idiopathic RLS. The treatment was efficacious both for nighttime and daytime symptoms in this indication and may carry a low risk of augmentation.

Topics: Cabergoline; Dopamine Agonists; Ergolines; Female; Humans; Male; Middle Aged; Restless Legs Syndrome; Severity of Illness Index; Time; Time Factors

To assess the efficacy and safety of the dopamine agonist cabergoline (CAB) in patients with restless legs syndrome (RLS).. Patients with moderate to severe RLS were randomized into four groups receiving placebo, 0.5 mg, 1 mg, or 2 mg CAB once daily in a double-blind, placebo-controlled, multicenter dose-finding trial followed by an open long-term extension trial of 47 weeks. Efficacy was assessed with the RLS-6 scales and International RLS Study Group severity scale (IRLS).. A total of 85 patients (age 56 +/- 10 years, 71% females) were treated. Severity of RLS-6 scale symptoms during the night (the primary endpoint) was markedly improved by all CAB doses compared to placebo (placebo: -1.4 +/- 3.1, 0.5 mg CAB: -4.2 +/- 3.0 [p = 0.0082], 1.0 mg CAB: -4.0 +/- 2.9 [p = 0.0040], 2.0 mg CAB: -4.8 +/- 3.7 [p = 0.0026]). Similar results were found for the RLS severity at bedtime and during the day, IRLS, and satisfaction with sleep. A stable, clinically relevant improvement was achieved in all efficacy measures (severity during the night: change between last assessment and baseline: -5.6 +/- 2.5, rate of remission: 71.2%) throughout 1 year with a mean CAB dose of 2.2 mg per day. During long-term treatment, 6 of 66 treated patients were affected (n = 2) or possibly affected (n = 4) by mild augmentation. Under CAB therapy up to 1 year, 11 of 85 patients discontinued treatment due to a drug-related adverse event.. Cabergoline is an efficacious and well-tolerated option for the treatment of restless legs symptoms during the night and the day.

Topics: Aged; Cabergoline; Dopamine Agonists; Dose-Response Relationship, Drug; Double-Blind Method; Ergolines; Female; Gastrointestinal Diseases; Hallucinations; Humans; Male; Middle Aged; Nervous System Diseases; Prospective Studies; Restless Legs Syndrome; Severity of Illness Index; Treatment Outcome

To evaluate the efficacy and the safety of cabergoline, a dopamine-receptor agonist with a long half-life, in restless legs syndrome (RLS).. A 2 month, single blind, open labeled clinical trial. Patients were evaluated with polysomnography at baseline (B), following 1 week of placebo (T0), and after 1 week (T1) and 2 months (T2) of cabergoline treatment. The clinical global impression was assessed using International RLS Study Group Rating Scale and nocturnal actigraphy.. Sleep Disorders Center.. Twelve patients with moderate to severe RLS (mean age 56.6 years) who were naive to treatment with dopaminergic agents.. Upward titration of cabergoline (from 0.5 mg to 2 mg) in a single evening dose.. Ten patients completed the study (mean dose, 1.1 mg), and all showed an improvement of RLS symptoms. The results from the International RLS Study Group Rating Scale showed similarities between B (24.3+/-2.9) and T0 (23.1+/-5.9; P=0.6), with significant improvement at T1 (12.5+/-6.0; P=0.01 vs B and T0) and T2 (9.8+/-6.9; P=0.001 vs B and P=0.005 vs T0). The mean nocturnal activity value measured by actigraphy during week 1 decreased from T0 (19.8+/-9.3) to T1 (13.6+/-6.4) and dropped significantly at T2 (8.5+/-5.3; P=0.05). Nine patients continued the treatment up to 12 months with consistent efficacy, few side effects, and no augmentation.. Low doses of cabergoline showed effectiveness and safety in patients with moderate to severe RLS, with no appearance of augmentation phenomenon. Double blind, crossover, polysomnographic studies are necessary to confirm this preliminary data.

Topics: Adult; Aged; Cabergoline; Dopamine Agonists; Ergolines; Female; Humans; Male; Middle Aged; Polysomnography; Restless Legs Syndrome; Single-Blind Method

Current treatment options for restless legs syndrome (RLS), based on the American Academy of Sleep Medicine practice parameters, favor dopaminergic agents. The drug of first choice is levodopa, which is now licensed for RLS in two European countries. However, the short duration of action and augmentation of symptoms under therapy may limit the clinical use of levodopa, especially in severely affected patients. An open pilot study shows that the long-acting dopamine agonist cabergoline is a promising new tool in the treatment of RLS. Results of a double-blind, controlled trial are pending.

Topics: Adult; Aged; Cabergoline; Dopamine Agents; Dose-Response Relationship, Drug; Double-Blind Method; Ergolines; Female; Humans; Male; Restless Legs Syndrome; Surveys and Questionnaires

To define the effective dose of cabergoline and to evaluate the tolerability and efficacy of cabergoline in patients with restless legs syndrome (RLS).. Treatment of idiopathic RLS patients with cabergoline in a 12-week open label trial. Patients on levodopa therapy were allowed to either stop levodopa prior to study entry or to continue, taper or discontinue levodopa during the study. Efficacy parameters were assessed by polysomnography and subjective ratings at baseline and at week 12. Primary efficacy parameters were the number of PLM and total sleep time.. Dept. of Neurology, Sleep Disorders Center. Nine patients with moderate to severe RLS (age 38.1 to 64.3 years, mean 54.1 years) who had experienced insufficient benefit under levodopa therapy and/or in part developed daytime augmentation participated. At study entry five patients were still under levodopa therapy (400-800 mg).. Up-titration of cabergoline (single evening dose) until RLS symptoms clearly improved. Initial comedication with domperidone 20 mg t.i.d.. At the endpoint all patients were on cabergoline monotherapy (mean dosage 2.1 mg, range 1 to 4 mg). Domperidone was stopped in all patients due to good tolerability. Polysomnographic data showed a significant reduction of the number of periodic leg movements (PLM) (195.8+/-109.1 (baseline) vs. 26.4+/-40.2 (12 weeks cabergoline monotherapy; p=0.002), PLM arousals (51.7+/-42.3 vs. 6.4+/-11.2; p=0.017) and PLM awakenings (10.4+/-7.8 vs. 1.0+/-1.7; p=0.001). Total sleep time was prolonged (302.7+/-50.7 vs. 379.4+/-59.8 min; p=0.018), sleep latency shortened (42.4+/-49.1 vs. 16.3+/-22.8 min; p=0.214) and sleep efficiency increased (63.1+/-10.5 vs. 79.1+/-12.5%; p=0.017). All patients reported a impressive relief or became free of RLS symptoms.. Cabergoline is effective and well tolerated in restless legs syndrome especially in patients with severe RLS and those who developed augmentation under levodopa therapy.

Topics: Adult; Cabergoline; Dopamine Agonists; Ergolines; Female; Humans; Male; Middle Aged; Polysomnography; Quality of Life; Receptors, Dopamine D2; Restless Legs Syndrome; Severity of Illness Index

Problems with impulse control and pathological gambling are known as possible side effects of dopaminergic therapy in patients with Parkinson's disease. We report 2 cases of pathological gambling induced by dopamine agonists in patients without Parkinson's disease. The first patient, a 46-year-old man, was treated with ropinirole for restless legs syndrome and had lost huge amounts of money in the context of internet-based poker game. Another 46-year-old male patient developed pathological gambling under treatment with cabergoline administered for prolactinoma. The two cases implicate pathological gambling as a possible consequence of dopaminergic treatment and support the increasing evidence regarding pathological gambling as an adverse drug reaction of dopaminergic treatment, also in patients who do not suffer from Parkinson's disease.

Topics: Antiparkinson Agents; Cabergoline; Dopamine Agonists; Ergolines; Gambling; Humans; Indoles; International Classification of Diseases; Male; Middle Aged; Pituitary Neoplasms; Prolactinoma; Restless Legs Syndrome

Dopaminergic agents are commonly used and effective treatments for restless legs syndrome (RLS), a disabling sensorimotor disorder. Less known are some of the potentially disabling side effects of these treatments, particularly iatrogenic gambling addiction, as is described here. Here the authors present a 62-year-old man, with a 20-year history of RLS, who developed gambling addiction while on dopaminergic treatment. He was not forewarned of this side effect, nor was he ever screened for gambling behaviours prior to or during treatment. Eight months after discontinuation of dopaminergic treatment and after 10 sessions of cognitive-behavioural therapy for gambling addiction, his gambling behaviours have partially resolved. To our knowledge, this is the first ever first person account of this condition. To prevent the devastating consequences of gambling addiction or to minimise its impact by early intervention, the authors call for clinicians involved in treatment of RLS to follow these simple measures: screen patients for gambling behaviours prior to the onset and during dopaminergic treatment; forewarn patients of this potential side effect; and if patients screen positive, refer them to specialist gambling treatment services, in addition to making necessary changes to their medication regime.

Topics: Cabergoline; Carbidopa; Cognitive Behavioral Therapy; Dopamine Agonists; Drug Combinations; Ergolines; Gambling; Humans; Indoles; Levodopa; Male; Middle Aged; Restless Legs Syndrome; Tetrahydronaphthalenes; Thiophenes

Topics: Aged; Analgesics, Opioid; Anesthesia, General; Cabergoline; Dopamine Agonists; Dopamine Uptake Inhibitors; Drug Interactions; Ergolines; Female; Humans; Hypertension; Restless Legs Syndrome; Selective Serotonin Reuptake Inhibitors; Spinal Fusion; Tramadol

Topics: Adult; Aged; Cabergoline; Dopamine; Dopamine Agonists; Ergolines; Humans; Middle Aged; Nocturnal Myoclonus Syndrome; Restless Legs Syndrome; Sleep Deprivation

Topics: Cabergoline; Disease Progression; Dopamine Agonists; Ergolines; Genetic Predisposition to Disease; Humans; Restless Legs Syndrome; Treatment Outcome

Topics: Apomorphine; Cabergoline; Dopamine Agonists; Ergolines; Europe; Humans; Restless Legs Syndrome; Tetrahydronaphthalenes; Thiophenes

Topics: Antiparkinson Agents; Cabergoline; Dopamine Agonists; Ergolines; Humans; Parkinson Disease; Restless Legs Syndrome