PERGOLIDE AND CARBIDOPA LEVODOPA TREATMENT OF THE RESTLESS LEGS SYNDROME AND PERIODIC LEG MOVEMENTS IN SLEEP IN A CONSECUTIVE SERIES OF PATIENTS/

Carbidopa/levodopa has become accepted as a primary treatment for both the restless legs (RL) syndrome and periodic leg movements in sleep ( PLMS). It, however, usually significantly augments the RL symptoms in the day as well as night, requiring medication change for about 70% of the patients. The dopaminergic agonist pergolide provides a potential ly useful treatment; doses given at dinner and before bed could suffic e to treat the symptoms for most of the 24-hour day. A series of conse cutive patients with RL syndrome or PLMS was studied using a standard medication protocol starting with carbidopa/levodopa, switching if nee ded to pergolide and, finally, to an opiate or other treatment. For 51 patients entered into the study, 21 (39%) continued on carbidopa/levo dopa and 26 (50%) switched to pergolide. For those tried on pergolide, 19 (73%) responded well. Restless legs augmentation occurred for only four (15%) and was severe enough to require medication change for onl y one (4%) of these patients. The patients with PLMS responded best to carbidopa/levodopa whereas severe RL patients responded best to pergo lide. Pergolide provided a good treatment for the RL syndrome, particu larly for the more severe RL cases without significant problems with R L augmentation.