シンポジウム25：ガイドライン（標準的神経治療）restless leg症候群
Restless legs syndromeの薬物療法
2025 年 42 巻 4 号 p. 650-656
詳細
2025 年 42 巻 4 号 p. 650-656
The efficacy of drug therapy (iron agents, dopaminergic drugs, α2δ ligands) was examined in the diagnostic guidelines of Restless Legs Syndrome (RLS) by the Japanese Society of Neurotherapy.
Randomized controlled trials (RCTs) were conducted in which papers were extracted from PubMed and medical journals for irons, dopamine agents, and α2δ ligands. The International RLS Severity Scale (IRLS) was used in these papers to assess efficacy in a meta–analysis. These results were evaluated the degree of recommendation by the RLS diagnostic Guidelines Committee.
For irons, we included RCT 7 studies. The meta–analysis results showed a significant reduction in IRLS scores compared to placebo (mean difference −4.25 ; 95% CI −6.39, −2.11). The Committee's assessment was that it was weakly recommended to use iron tablets for the treatment of RLS (2B).
For dopamine agonists, we included RCT 21 studies. The meta–analysis results showed a significant reduction in IRLS scores compared to placebo (mean difference −5.47 ; 95% CI −6.33, −4.62). The Committee's assessment was that the use of dopamine agonists was recommended for the treatment of RLS (1A).
The efficacy of levodopa as a short–term treatment was reported in only one RCT1 study in a small study. In the evaluation of the committee, it was recommended to limit the treatment to 2∼3 times a week (1C).
For α2δ ligands, we included RCT 7 studies. The meta–analysis results showed a significant reduction in IRLS scores compared to placebo (mean difference −7.08 ; 95% CI −9.05, −5.11). The Committee's assessment was that the use of dopamine agonists was recommended for the treatment of RLS (1A).
It was reported that long–term use of dopamine agents has a risk of developing augmentation, in which RLS symptoms become more severe than before the start of treatment, symptoms become more widespread, and the response to therapeutic drugs decreases. On the other hand, α2δ ligand drugs had adverse events such as somnolence and dizziness, but no augmentation was reported.
The use of irons, dopamine agonists, and α2δ ligand drugs is recommended as drug therapy for the treatment of RLS. Because of the risk of augmentation with dopaminergic drugs, the choice of α2δ ligand preparations should be considered in patients with early RLS depending on the patient's background.
