EFFECT OF PERGOLIDE ON RESTLESS LEGS AND LEG MOVEMENTS IN SLEEP IN UREMIC PATIENTS

Restless legs syndrome (RLS) and periodic limb movements in sleep (PLM S) are disorders that are common and disturbing to uremic patients. Th e treatment of these is problematic. Eight patients on chronic hemodia lysis and continuous peritoneal dialysis completed a double-blind plac ebo-controlled crossover study using incremental doses of pergolide up to 0.25 mg at bedtime for treatment of RLS and sleep disruption. Five patients (62.5%) noted subjective improvement in restless legs sympto ms and sleep quality. Objective results were improved only slightly by treatment. The percentage of the first hour in bed during which leg m ovements occurred decreased from 20.5+/-6.0 to 11.5+/-3.3, p<0.05. How ever, findings during sleep were less positive. The following measures were not significant between placebo and treatment: leg movements per hour of sleep [53.7+/-22.3 vs 35.8+/-11.8 (p=0.2)]; and percentage of sleep time spent with leg movements [5.5%+/-3.2 vs 4.4%+/-1.4 (p=0.37 )], Patients continued to have very disrupted sleep, and we could not document an objective improvement in sleep architecture. Thus, althoug h pergolide at the dose of 0.25 mg at bedtime provided subjective impr ovement in symptoms of restless legs and quality of sleep, and objecti vely decreased leg movements during the first hour in bed, objectively sleep continued to be disrupted. In this small patient group, the res ponse to pergolide was not uniform, and further investigation is requi red to test effectiveness at higher doses.