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Tweaking the treatment for restless legs

ttable tendency to turn traitor. The medicine can actually begin to worsen symptoms."

In their paper, which was written together with nurse practitioner Cheryl Deeley, Richard and Kurlan examine the cases of two older women who have the syndrome. Typically, patients move their legs frequently and are often irked by a life of pacing in the wee morning hours, or in the worst cases, being unable to take road trips or even sit through a movie.

In both cases, and in most other patients the doctors have treated, they have found it helpful to switch the medications that patients receive. Sometimes the medication is no longer useful or helpful. But more often, the approved medications actually began to trigger the symptoms they were supposed to prevent, a phenomenon called augmentation. Richard and Kurlan have seen several patients whose symptoms eased immediately after treatment with the new medications began, but whose symptoms then worsened markedly later.

"At this point, you cant just up the dose," Kurlan said, "The drug is part of the problem."

Augmentation is similar to what occurs when patients use painkillers for an extended period of time to treat their tension headaches. Soon, the medication actually triggers the headaches and worsens them. Thats why such painkillers, though effective in the short term, usually cant be taken regularly and indefinitely without a painful price.

In their report, the doctors say that the new medication for restless leg syndrome worked in one of the patients for seven months before she had to be switched to other medications. In the other, it worked for a few years before switching was required.

In the wake of FDA approval for Requip and Mirapex (pramipexole), along with the attendant heavy advertising, Kurlan and Richard stress the importance to both primary care physicians and patients alike of understanding the risks of relying on these medications for too long.

"The best drugs f
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Contact: Becky Jones
rebecca_jones@urmc.rochester.edu
585-275-8490
University of Rochester Medical Center
20-Dec-2006


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