Restless legs syndrome is a neurological disorder in which there is an overwhelming urge to move the legs in response to uncomfortable feelings. According to the National Institute of Neurological Disorders and Stroke, these feelings are described as creeping, tugging or burning, and range in intensity from irritating to painful. Treatment aims at underlying causes. Sometimes an underlying cause is not found or treating it fails to alleviate the restless legs. In that case, treatment is aimed at the symptoms.
Treatment of Underlying Conditions
Problems with nerves in the body, called peripheral neuropathy, are associated with restless legs syndrome. Peripheral neuropathy has a number of causes including alcoholism, vitamin B12 deficiency and diabetes. Medical treatment and drug rehabilitation programs can help alcoholism. Vitamin B12 deficiency is addressed with B12 supplements; treatments for diabetes include dietary management, appropriate exercise and medications such as insulin or metformin.
Diseases in which iron is insufficiently utilized by the body are also linked to the disorder. These include iron deficiency, kidney failure, rheumatoid arthritis, pregnancy and Parkinson's disease. Treatment of iron deficiency involves supplementation of iron and treating the source of iron loss; this may entail stopping a GI bleed, for example. Kidney failure, if permanent, requires dialysis and a kidney transplant. Rheumatoid arthritis is treated with immune system suppressants. Supplementation with iron during pregnancy can offset an iron deficit; treatment of Parkinson's disease generally entails giving medicines such as levodopa/carbidopa that increase the amount of dopamine in the brain.
Lifestyle Changes and Activities
Certain factors can aggravate restless legs syndrome in some people. Various antidepressants, antinausea medications, cold and allergy medications, antipsychotics and calcium channel blockers may need to be avoided. In addition, caffeine, alcohol and tobacco can aggravate the disorder. It may be helpful to supplement with iron, magnesium and folate.
Other people find that massages, hot baths, and heat or ice packs provide some, but not complete relief. A moderate amount of exercise helps some patients, though others report that excess exercise makes the symptoms worse. Some people find a regular sleep pattern, or changing their sleep pattern, to be helpful.
An article published in Mayo Clinic Proceedings notes that mental alerting activities during times of boredom, such as crossword puzzles or video games, may also be useful.
Medications
There are four types of drugs for the treatment of restless legs syndrome. The first-line treatment is with drugs used to treat Parkinson's disease. These drugs increase the concentration of the chemical dopamine in the brain. Ropinirole and pramipexole are both approved for this use.
Another class of drugs sometimes used are antiseizure medications. Gabapentin and carbemazepime are two such drugs.
Opioids are pain medications that can be helpful, but also can be habit forming. Examples of these drugs include codeine, hydrocodone, oxycodone and methadone.
The fourth class of drugs used are called benzodiazepines. These are typically used for sleep or anxiety disorders, and have shown some usefulness in restless legs syndrome. Examples include clonazepam and temazepam.
References
- National Institute of Neurological Disorders and Stroke: Restless Legs Syndrome Fact Sheet
- National Heart Lung and Blood Institute: What Causes Restless Legs Syndrome?
- "Mayo Clinic Proceedings"; An algorithm for the management of restless legs syndrome.; Silber et al; July 2004
- MayoClinic.com: Restless legs syndrome: Treatments and drugs
- "Harrison's Principles of Internal Medicine"; 17th ed.; Fauci et al; 2008
