L-Dopa improves Restless Legs Syndrome and periodic limb movements in sleep but not Attention-Deficit-Hyperactivity Disorder in a double-blind trial in children

Background: In a previous open-label study, dopaminergic agents improved Restless Legs Syndrome (RLS) and Periodic Limb Movements in Sleep (PLMS), as well as Attention-Deficit-Hyperactivity Disorder (ADHD) in children with both disorders. We therefore conducted a double-blind placebo-controlled trial of l-DOPA in ADHD children with and without RLS/PLMS. Methods: Two groups of patients (total n=29), those with ADHD only or those with ADHD and RLS/PLMS, were randomized to l-DOPA or placebo therapy. At baseline and after therapy patients were assessed with Conners' parent and teacher rating scales; polysomnography; RLS rating scale; and neuropsychometric measures of memory, learning, attention, and vigilance. Results: l-DOPA improved RLS/PLMS symptoms in all patients with those disorders compared with placebo (p=.007). When assessed by the Conners' Scales before therapy, ADHD was more severe in children without RLS/PLMS than in children with RLS/PLMS (p=0.006). l-DOPA had no effect on Conners' scales, sleep, or neuropsychometric tests when all patients treated with the drug were compared to those on placebo or when patients with ADHD only were compared to those with ADHD and RLS/PLMS. Conclusions: In this first double-blind study of a dopaminergic therapy in children with RLS/PLMS, l-Dopa significantly improved RLS/PLMS but not ADHD. These results, however, should be interpreted carefully since they may have been influenced by the relatively small sample size and the baseline differences in severity of ADHD symptoms. Further work needs to be done to elucidate the relationship between dopamine, ADHD and RLS/PLMS.