Case Report ARTICLE
Clinic study of restless leg syndrome (RLS) accompanying with psychological symptoms induced by large-dose treatment of madopar
- 1Department of Neurology, First People's Hospital of Huainan, China
- 21 Department of Neurology, The First People's Hospital of Huainan, China
- 3State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, China
- 4Beijing Institute for Brain Disorders (BIBD), China
Objectives: Some neurological disorders show an indistinguishable psychological symptom at an early stage, especially when accompanying with jitter similar to Parkinson's disease. During the dopamine replacement therapy, some patients represent restless leg syndrome (RLS)-like symptoms. We aimed to analyze the treatment strategy and prognosis of RLS caused by large-dosage madopar.
Methods: Nine cases showing symptoms of anxiety, depression and somatization were recruited due to misdiagnosis of Parkinson's disease and taking a large dose of madopar. Clinical data were collected and strategies of treatment and prognosis were analyzed.
Results: Seven patients had different degree of anxiety and depressive disorder, and the other 2 cases were misdiagnosed as Parkinson's disease. During madopar treatment, these cases showed gradually aggravated symptoms of acid swelling, numbness and pain, and other indescribable sensory abnormalities in both lower extremities, which spread to both upper extremities in a few patients. Among 7 patients, the symptoms of anxiety, depression, insomnia and somatization significantly worsen during time. The average time for 9 patients from taking madopar to the appearance of RLS was 2.6±0.6 months, the average time to clinic diagnosis was 18.17±9.40 months, and average dosage of madopar was 1.44±0.21 g per day. A strategy with gradually reducing the madopar dosage and giving a small dose of long-acting dopamine preparation were used, which greatly alleviated the symptoms after following up for 3 months.
Conclusion: Large dosage madopar can cause RLS-like symptoms accompanied by anxiety, depression, insomnia and other mental symptoms, which should be highly paid attention by clinicians.
Keywords: madopar, Restless Leg Syndrome, Anxiety, Depression, Psychological symptoms
Received: 04 Sep 2018;
Accepted: 08 May 2019.
Edited by:Chunxue Wang, Department of Neuropsychiatry, Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, China
Reviewed by:Chun-Feng Liu, Second Affiliated Hospital of Soochow University, China
Li Cao, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, China
Copyright: © 2019 Zhu, Li, Ren, Zhang, Xue, Yu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Dr. Mei Zhang, 1 Department of Neurology, The First People's Hospital of Huainan, Huainan, China, firstname.lastname@example.org
MD, PhD. Weili Zhang, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, Beijing Municipality, China, email@example.com