Restless legs syndrome/Willis-Ekbom disease (RLS/WED) causes a strong urge to move legs while resting. Restless legs syndrome/WED is an often-inherited disease occurring in 3% to 10% of adult populations, increasing with age. Severity varies from mild disturbance of sleep to painful restless legs and arms, loss of sleep, fatigue, and risk of suicide. Dopaminergic drugs relieve symptoms, but cause augmentation, ie, initially helpful but later increase the burden of symptoms. Oral gabapentinoids and opioids are often added, but opioid tolerance and adverse effects are common. With the high prevalence and incomplete help from oral drugs, significant unmet needs exist for effective therapy for severe RLS/WED. Ongoing spinal intrathecal infusion of low-dose morphine is effective, but not generally recognized, as only 12 cases have been published since 2002. We report 7 patients suffering from severe RLS/WED, who had no relief from oral dopaminergic, gabapentinoid, or opioid drugs; they all had excellent relief during ongoing spinal intrathecal infusion of morphine at only 1 to 5 μg/h, ongoing for 1 to 21 years without need of higher doses of morphine.. We suggest that morphine may be transported with the cerebrospinal fluid reaching and readjusting malfunctioning dopamine neuronal systems in the brain and spinal cord. The effects last only as long as the infusion continues. A patient with RLS/WED and persistent genital arousal disorder (PGAD) was relieved of both RLS/WED and PGAD symptoms. These case reports suggest that intrathecal infusion of low-dose morphine is an effective treatment of severe RLS.

中文翻译：

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长期鞘内输注低剂量吗啡可有效缓解严重不宁腿综合征/Willis-Ekbom 病的症状，而不会诱导阿片类药物耐受。


不宁腿综合征/Willis-Ekbom 病 （RLS/WED） 会导致在休息时强烈地移动双腿的冲动。不宁腿综合征/WED 是一种经常遗传的疾病，发生在 3% 至 10% 的成年人口中，随着年龄的增长而增加。严重程度从轻度睡眠障碍到腿部和手臂不安疼痛、睡眠不足、疲劳和自杀风险不等。多巴胺能药物可缓解症状，但会引起加重，即最初有帮助，但后来增加了症状的负担。经常加用口服加巴喷丁类药物和阿片类药物，但阿片类药物耐受性和不良反应很常见。由于口服药物的高患病率和不完全的帮助，对严重 RLS/WED 的有效治疗存在大量未满足的需求。持续脊髓鞘内输注低剂量吗啡是有效的，但未得到普遍认可，因为自 2002 年以来仅发表了 12 例病例。我们报告了 7 例患有严重 RLS/WED 的患者，他们口服多巴胺能、加巴喷丁类或阿片类药物没有缓解;他们在持续脊髓鞘内输注吗啡时，仅以1到5微克/小时的速度都有极好的缓解效果，持续1到21年，无需更高剂量的吗啡。我们认为吗啡可能通过脑脊液到达并重新调整大脑和脊髓中功能失调的多巴胺神经元系统进行运输。只要输注继续，效果才会持续。一名 RLS/WED 和持续性生殖器唤起障碍 （PGAD） 患者的 RLS/WED 和 PGAD 症状均得到缓解。这些病例报告表明，鞘内输注低剂量吗啡是治疗重度 RLS 的有效方法。