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 potentially useful treatment; doses given at dinner and before bed could suffice to treat the symptoms for most of the 24-hour day. A series of consecutive patients with RL syndrome or PLMS was studied using a standard medication protocol starting with carbidopa/levodopa, switching if needed to pergolide and, finally, to an opiate or other treatment. For 51 patients entered into the study, 21 (39%) continued on carbidopa/levodopa 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 only one (4%) of these patients. The patients with PLMS responded best to carbidopa/levodopa whereas severe RL patients responded best to pergolide. Pergolide provided a good treatment for the RL syndrome, particularly for the more severe RL cases without significant problems with RL augmentation.