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Pharmacopsychiatry 2003; 36(2): 70-72
DOI: 10.1055/s-2003-39047
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Transient Restless Legs-like Syndrome as a Complication of Opiate Withrawal

N. Scherbaum1 , B. Stüper1 , U. Bonnet1 , M. Gastpar1
  • 1Department of Psychiatry and Psychotherapy, University Hospital, Essen, Germany
Further Information

Publication History

Received: 15.11.2001 Revised: 17.5.2002

Accepted: 1.7.2002

Publication Date:
06 May 2003 (online)

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In most cases, restless legs syndrome (RLS) is an idiopathic disorder affecting patients of middle and older age. Usually, the intensity of symptoms is constant or progressive. Here, we describe two opiate addicts developing RLS during opiate withdrawal. Their RLS disappeared along with the remission of withdrawal symptoms. Both cases responded well to a treatment with Madopar® (L-dopa plus benserazid). This observation encouraged us to perform a retrospective analysis of all cases of opiate addicts detoxified in our unit during a 5-month period. This analysis revealed 15 out of 120 patients who had described the symptoms of transient RLS emerging during opiate detoxification treatment. Transient RLS during opiate detoxification merits further interst in order to improve the treatment of sleep disturbances during detoxification and as a model of interaction of the dopaminergic and endorphine system in motor activity.

References

  • 1 Angulo J A, McEwen B S. Molecular aspects of neuropeptide regulation and function in the corpus striatum and the nucleus accumbens.  Brain Res Brain Res Rev. 1994;  19 1-28
    CrossrefPubMedGoogle Scholar
  • 2 Barnes T RE. A rating scale for drug-induced akathisia.  Br J Psychiatry. 1989;  154 672-676
    CrossrefPubMedGoogle Scholar
  • 3 Bonnet U, Banger M, Wolstein J, Gastpar M. Choreoathetoid movements associated with rapid adjustment to methadone.  Pharmacopsychiatry. 1998;  31 143-145
    PubMedGoogle Scholar
  • 4 Brüne M, Bräunig P. Akathisie.  Fortschr Neurol Psychiatr. 1997;  65 396-406
    PubMedGoogle Scholar
  • 5 Brodeur C, Montplaisir J, Godbout R, Marinier R. Treatment of restless legs syndrome and periodic movements during sleep with L-dopa: a double-blind controlled study.  Neurology. 1988;  38 1845-1848
    PubMedGoogle Scholar
  • 6 Feigen A. Restless legs syndrome.  JAMA. 1995;  274 1191-1192
    CrossrefPubMedGoogle Scholar
  • 7 Freye E, Levy J. Acute abstinence syndrome following abrupt cessation of long-term use of tramadol (Ultram): a case study.  Eur J Pain. 2000;  4 307-311
    CrossrefPubMedGoogle Scholar
  • 8 Glasauer F E. Restless legs syndrome.  Spinal Cord. 2001;  39 125-133
    CrossrefPubMedGoogle Scholar
  • 9 Gossop M. The development of a short opiate withdrawal scale (SOWS).  Add Behav. 1990;  15 487-490
    CrossrefPubMedGoogle Scholar
  • 10 Handwerker J V, Palmer R F. Clonidine in the treatment of ”restless leg” syndrome.  N Engl J Med. 1985;  313 1228-1229
    PubMedGoogle Scholar
  • 11 Hening W A, Walters A, Kavey N, Gidro-Frank S, Cote L, Fahn S. Dyskinesias while awake and periodic movements in sleep in restless legs syndrome: treatment with opioids.  Neurology. 1986;  36 1363-1366
    PubMedGoogle Scholar
  • 12 Kaplan P W, Allen R P, Buchholz D W, Walters J K. A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/levodopa and propoxyphene.  Sleep. 1993;  16 717-723
    PubMedGoogle Scholar
  • 13 Lauerma H, Markkula J. Treatment of restless legs syndrome with tramadol: an open study.  J Clin Psychiatry. 1999;  60 241-244
    PubMedGoogle Scholar
  • 14 Leckman J F, Peterson B S, Anderson G M, Arnsten A F, Pauls D L, Cohen D J. Pathogenesis of Tourette’s syndrome.  J Child Psychol Psychiatry. 1997;  38 119-142
    PubMedGoogle Scholar
  • 15 O’Keeffe S T. Restless legs syndrome. A review.  Arch Intern Med. 1996;  156 243-248
    CrossrefPubMedGoogle Scholar
  • 16 Morris B J, Johnston H M. A role for hippocampal opioids in long-term functional plasticity.  Trends Neurosci. 1995;  18 350-355
    CrossrefPubMedGoogle Scholar
  • 17 Saletu M, Anderer P, Saletu-Zyhlarz G, Prause W, Semler B, Zoghlami A, Gruber G, Hauser C, Saletu B. Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD): acute placebo-controlled sleep studies with clonazepam.  Eur Neuropharmacol. 2001;  11 153-161
    PubMedGoogle Scholar
  • 18 Sandyk R. The endogenous opioid system in neurological disorders of the basal ganglia.  Life Sci. 1985;  37 1655-1663
    CrossrefPubMedGoogle Scholar
  • 19 Sandyk R, Bamfort C R, Gillman M A. Opiates in restless legs syndrome.  Int J Neurosc. 1987;  36 99-104
    PubMedGoogle Scholar
  • 20 Singer H S. Neurobiological issues in Tourette syndrome.  Brain Dev. 1994;  16 353-364
    CrossrefPubMedGoogle Scholar
  • 21 Stiasny K, Wetter T C, Trenkwalder C, Oertel W H. Restless legs syndrome and its treatment by dopamine agonists.  Parkinsonism Rel Disord. 2000;  7 21-25
    PubMedGoogle Scholar
  • 22 Trenkwalder C, Wetter T C, Stiasny K, Clarenbach P. Restless-legs-Syndrom und ”periodic limb movements in sleep”.  Nervenarzt. 2001;  72 425-436
    CrossrefPubMedGoogle Scholar
  • 23 Walker J M, Thompson L A, Frascella J, Friederich M W. Opposite effects of mu and kappa opiates on the firing-rate of dopamine cells in the substantia nigra of the rat.  Eur J Pharmacology. 1987;  134 53-59
    PubMedGoogle Scholar
  • 24 Walters A S, Wagner M L, Hening W A, Grasing K, Mills R, Chokroverty S, Kavey N. Successful treatment of idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo.  Sleep. 1993;  16 327-332
    PubMedGoogle Scholar
  • 25 Walters A S. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group.  Mov Disord. 1995;  10 634-642
    CrossrefPubMedGoogle Scholar
  • 26 Wetter T C, Pollmacher T. Restless legs and periodic leg movements in sleep syndromes.  J Neurol. 1997;  244 (4 Suppl 1) S37-45
    CrossrefPubMedGoogle Scholar
  • 27 Zoe A, Wagner M L, Walters A S. High-dose clonidine in a case of restless legs syndrome.  Ann Pharmacother. 1994;  28 878-881
    PubMedGoogle Scholar

Privat-Dozent Dr. Norbert Scherbaum

Department of Psychiatry and Psychotherapy

University of Essen

Virchowstr. 147

45147 Essen

Germany

Phone: +49-201-7227-180

Fax: +49-201-7227-303

Email: norbert.scherbaum@uni-essen.de

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