jueves, 16 de julio de 2015

Tramadol y piernas inquietas / Tramadol for restless legs syndrome

Revisión de las estrategias de manejo en el síndrome de piernas inquietas o enfermedad de Willis-Ekbon
A review of current treatment strategies for restless legs syndrome (Willis-Ekbom disease).
Klingelhoefer L, Cova I, Gupta S, Chaudhuri KR.
Clin Med. 2014 Oct;14(5):520-4. doi: 10.7861/clinmedicine.14-5-520.
Restless legs syndrome (RLS), recently renamed Willis-Ekbom disease (WED), is a common movement disorder. It is characterised by the need to move mainly the legs due to uncomfortable, sometimes painful sensations in the legs, which have a diurnal variation and a release with movement. Management is complex. First, centres should establish the severity of RLS using a simple 10-item RLS severity rating scale (IRLS). They should also exclude secondary causes, in particular ensuring normal iron levels. Mild cases can be managed by lifestyle changes, but patients with a IRLS score above 15 usually require pharmacological treatment. Dopaminergic therapies remain the mainstay of medical therapies, with recent evidence suggesting opioids may be particularly effective. This article focuses on the different treatment strategies in RLS, their associated complications and ways to manage them.
KEYWORDS: RLS; Restless legs syndrome; medical treatment; side effects; therapy
Consenso revisado de la Fundación Willis-Ekbom Disease Foundation sobre el tratamiento del síndrome de piernas inquietas.
Willis-Ekbom Disease Foundation revised consensus statement on the management of restless legs syndrome.
Silber MH1, Becker PM, Earley C, Garcia-Borreguero D, Ondo WG; Medical Advisory Board of the Willis-Ekbom Disease Foundation.
Collaborators (12)
Mayo Clin Proc. 2013 Sep;88(9):977-86. doi: 10.1016/j.mayocp.2013.06.016.
Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is a common disorder, occurring at least twice a week and causing at least moderate distress in 1.5% to 2.7% of the population. It is important for primary care physicians to be familiar with this disorder and its management. Much has changed in its management since our previous algorithm was published in 2004, including the availability of several new drugs. This revised algorithm was written by members of the Medical Advisory Board of the Willis-Ekbom Disease Syndrome Foundation based on scientific evidence and expert opinion. It considers the management of RLS/WED under intermittent RLS/WED, chronic persistent RLS/WED, and refractory RLS/WED. Nonpharmacological approaches, including mental alerting activities, avoiding substances or medications that may exacerbate RLS, and the role of iron supplementation, are outlined. Chronic persistent RLS/WED should be treated with either a nonergot dopamine agonist or a calcium channel α-2-δ ligand. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS/WED and describe management approaches, including combination therapy and the use of high-potency opioids.
KEYWORDS: MAB; Medical Advisory Board; RLS; WED; Willis-Ekbom disease; restless legs syndrome
Anestesia y Medicina del Dolor
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