Restless legs syndromeの治療

Update on the Treatment of Restless Legs Syndrome

はじめに

　レストレスレッグス症候群（restless legs syndrome：RLS）では下肢を中心とした不快な感覚が出現し，脚を動かしたいという強い欲求が生じる。この症状は重度の不眠の原因となり，QOLの著しい低下を招くとともに，抑うつや焦燥感の精神症状を引き起こすため，治療戦略の構築が求められている。

　本稿ではこれまでに提出されたRLSの病態仮説を概観し，ある程度確立され，効果の検証が進んでいる治療法の位置づけについて考え，RLSに対する非薬物療法，薬物療法の現状を展望する。

Abstract

　Restless legs syndrome (RLS) is a sensorimotor disorder characterized by an irresistible urge to move the legs,accompanied by uncomfortable and unpleasant sensations that diminish with motor activity and worsen at rest.　The symptoms of this syndrome worsen in the evening and at night,leading to difficulty in sleeping.　Treatment of RLS includes non-pharmacological intervention and drug therapy.　In this article,we examine recent developments in the understanding of the pathophysiology of RLS and review previous articles on the treatment of RLS.　Although there have been no reports on formal studies on the nonpharmacologic strategies for RLS symptoms,recommened good sleep hygiene is considered essential to improve the comorbid insomnia.　Massaging the affected legs,taking hot baths,and performing mentally demanding tasks have been reported to reduce RLS symptoms.　Four categories of medications,namely,dopaminergic agents,opioids,anticonvulsants,and benzodiazepines were identified as frequently prescribed drugs for RLS.　Dopaminergic agonists are now considered the first-line treatment of RLS because they are more effective and produce augmentation less frequently as compared to L-dopa.　Opioids are prescribed to patients with severe conditions,especially those unresponsive to other treatments.　Currently,carbamazepine is not recommended for the treatment of RLS.　More recently,studies on the use of anticonvulsants for the treatment of RLS have focused on gabapentin.　Benzodiazepines,including clonazepam and nitrazepam,are widely prescribed,but their therapeutic effects on RLS symptoms were rather modest.　Therefore,benzodiazepines are mostly used to improve the sleep quality in patients with RLS.