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Restless-legs-Syndrom, periodische Gliedmaßenbewegungen im Schlaf und Psychopharmakologie

Restless legs syndrome, periodic limb movements, and psychopharmacology

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Zusammenfassung

Das Restless-legs-Syndrom (RLS) und das Syndrom der periodischen Gliedmaßenbewegungen (PLMS) finden sich in der Allgemeinbevölkerung mit einer hohen Prävalenz als primäre Form. Neben organischen Faktoren kann ein sekundäres RLS/PLMS durch verschiedene Medikamente, vor allem durch Psychopharmaka, ausgelöst werden. In Fallberichten und kleinen Fallserien wurden bei einigen Antidepressiva, Antipsychotika, Lithium und einem Entzug von Opioiden eine Auslösung oder Verstärkung eines RLS und PLMS beschrieben, während verschiedene als Phasenprophylaktika eingesetzte Antiepileptika sowie einige Benzodiazepine von therapeutischem Nutzen sein können. Systematische Untersuchungen oder kontrollierte Studien zu diesen unerwünschten Effekten von Psychopharmaka sind bislang nicht durchgeführt worden. Zu den Antidepressiva mit einer erhöhten Auftretenswahrscheinlichkeit von RLS/PLMS zählen die selektiven Serotoninwiederaufnahmehemmer, Venlafaxin sowie einige tetrazyklische Antidepressiva; für verschiedene trizyklische Substanzen wurden vermehrt PLMS beobachtet. Für einige Antidepressiva mit anderem Transmitterprofil wie etwa Bupropion wurden in meist kleineren Studien RLS-/PLMS-lindernde oder zumindest diesbezüglich neutrale Effekte (Trazodon, Nortriptylin) beschrieben.

Im Falle eines Fortbestehens oder eines Neuauftretens einer Insomnie unter Psychopharmakotherapie sollte eine genaue Anamnese erhoben werden, um das Vorliegen eines RLS/PLMS als mögliche unerwünschte Arzneimittelwirkung zu identifizieren. Falls klinisch möglich, sollte ein Umsetzversuch auf eine andere Substanz vorgenommen werden. Zur Behandlung eines RLS/PLMS bei psychotischen Patienten kann zusätzlich zum Umsetzen des Antipsychotikums eine Behandlung mit einem Antiepileptikum oder einem Benzodiazepin in Erwägung gezogen werden.

Summary

Restless legs syndrome (RLS) and the often associated periodic limb movement disorder in sleep (PLMD) frequently occur in the general population as a primary disorder. In addition to organic disease, secondary forms are caused by psychotropic medication. Several antidepressants, antipsychotics, lithium, and opioid withdrawal have been shown to induce or exacerbate RLS and PLMD, while several antiepileptics used as mood stabilizers and some benzodiazepines demonstrate therapeutic potential for treating RLS/PLMD. Systematic or controlled studies for evaluating these side effects still do not exist. Among the antidepressants at higher risk of inducing this disorder are selective serotonin reuptake inhibitors, venlafaxine, and some tetracyclic antidepressants. Under medication with some tricyclic substances, periodic limb movements were observed more often. For some antidepressants with differing transmitter profiles such as bupropion RLS/PLMD ameliorating effects or at least neutral effects (Trazodon, Nortriptylin) have been described in small studies. In case of continued of or newly occurring insomnia a thorough history should be taken to identify a possible RLS/PLMD as an intolerable side effect of treatment. A change in medications should be considered if clinically feasible. In case of RLS/PLMD occurring in psychotic patients switching the antipsychotic and additionally using a second line medication such as antiepileptics or a benzodiazepine should be considered.

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  1. AG Schlafforschung & Klinische Chronobiologie, Institut für Physiologie, Charité, Universitätsmedizin Berlin, Berlin, Deutschland

    S. Cohrs, A. Rodenbeck & D. Kunz

  2. Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Straße 5–11, 10115, Berlin, Deutschland

    S. Cohrs

  3. Abteilung für Psychiatrie und Psychotherapie, Georg-August-Universität Göttingen, Göttingen, Deutschland

    S. Cohrs & A. Rodenbeck

  4. Interdisziplinäres Schmerzzentrum und Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    M. Hornyak

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Cohrs, S., Rodenbeck, A., Hornyak, M. et al. Restless-legs-Syndrom, periodische Gliedmaßenbewegungen im Schlaf und Psychopharmakologie. Nervenarzt 79, 1263–1272 (2008). https://doi.org/10.1007/s00115-008-2575-2

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