This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Restless legs syndrome and impusive control disorders

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Restless legs syndrome (RLS) is a common sleep related movement disorder associated with mood and cognitive disorders (1,2)

Non-ergot-derived dopamine agonists (DA) such as ropinirole, pramipexole, and rotigotine are the first-line treatment of RLS with rapid efficacy, generally at low doses.

  • however, dopamine agonists may cause side effects such as impulse control disorders such as binge eating, compulsive shopping, gambling disorder or compulsive sexual behavior
  • DA used in RLS have high selective affinity for the D2/D3 receptor subtypes, which are expressed predominantly in the brain limbic areas, regions that are implicated in addiction and impulse control disorders (ICDs) (3)
  • unclear why some RLS patients develop these complications while others do not
  • DA dose does not correlate with the incidence of ICDs in RLS patients (8)

Abnormal reward-mediated processing is frequently observed in human disorders

  • in Parkinson disease (PD), use of the D2/ D3 selective receptor agonists is associated with an increased risk of ICD including pathological gambling, compulsive buying, compulsive sexual behavior, and binge or compulsive eating
    • prevalence rates of ICDs in DA-treated patients with PD is 13.6%, compared to 0.5-1% in the general population (4,5)

As opposed to PD, the relationship between ICDs and DA in RLS is not as well established, with prevalence estimates for ICDs and/or addictive behaviors ranging from 5-17% (6,7)

  • however Heim B et al noted, albeit via a retrospective case-control study, that patients with RLS with augmentation with DA therapy have an almost 6-fold increased risk of exhibiting ICD symptoms (8)

Reference:

  • Pearson VE, Allen RP, Dean T, Gamaldo CE, Lesage SR, Earley CJ. Cognitive deficits associated with restless legs syndrome (RLS). Sleep Med 2006;7:25-30.
  • Gamaldo CE, Benbrook AR, Allen RP, Oguntimein O, Earley CJ. A further evaluation of the cognitive deficits associated with restless legs syndrome (RLS). Sleep Med 2008;9:500-5.
  • Manconi M, Ferri R, Zucconi M, et al. Preferential D2 or preferential D3 dopamine agonists in restless legs syndrome. Neurology 2011;77:110-7.
  • Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2005;66:564-74.
  • Weintraub D, Koester J, Potenza MN, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol 2010;67:589-95
  • Dang D, Cunnington D, Swieca J. The emergence of devastating impulse control disorders during dopamine agonist therapy of the restless legs syndrome. Clin Neuropharmacol 2011;34:66-70.
  • Voon V, Schoerling A, Wenzel S, et al. Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome. BMC Neurol 2011;11:117
  • Heim B et al. Augmentation and impulsive behaviors in restless legs syndrome: Coexistence or association?Neurology. 2016 Jul 5;87(1):36-40

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.