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RESTLESS LEGS SYNDROME TREATMENTS |
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The first step in treatment is to treat
existing conditions that are known to be associated with Restless Legs Syndrome and
that will be identified by blood tests. If the patient is anemic,
iron (iron sulfate) or vitamin supplements (folate or vitamin B12)
will be prescribed. If kidney disease is identified as a cause,
treatment of the kidney problem will take priority. Prescription drugs In some people whose symptoms cannot be linked to a treatable associated condition, drug therapy may be necessary to provide relief and restore a normal sleep pattern. Prescription drugs that are normally used for Restless Legs Syndrome include: Benzodiazepines and low-potency opioids. These drugs are prescribed for use only on an "as needed" basis, for patients with mild Restless Legs Syndrome. Benzodiazepines appear to reduce nighttime awakenings due to PLMS. The benzodiazepine most commonly used to treat Restless Legs Syndrome is clonazepam (Klonopin, Rivotril). The main disadvantage of this drug type is that it causes daytime drowsiness. It also causes unsteadiness that may lead to accidents, especially for an elderly patient. Opioids are narcotic pain relievers. Those commonly used for mild Restless Legs Syndrome are low potency opioids, such as codeine (Tylenol #3) and propoxyphene (Darvocet). Studies have shown that these can be successfully used in the treatment of Restless Legs Syndrome on a long-term basis without risk of addiction. However, narcotics can cause constipation and difficulty urinating. Levodopa (L-dopa) and carbidopa (Sinemet). Levodopa is the drug most commonly used to treat moderate or severe Restless Legs Syndrome. It acts by supplying a chemical called dopamine to the brain. It is often taken in conjunction with carbidopa to prevent or decrease side effects. Although it is effective against Restless Legs Syndrome, levodopa may also causes a worsening of symptoms during the afternoon or early evening in 50-80% of patients. This phenomenon is known as "restless legs augmentation," and if it occurs, the physician will probably discontinue Levodopa for a brief period while an alternate drug is used. Levodopa can often be reintroduced after a short break. Pergolide (Permax). Pergolide acts on the same part of the brain as Levodopa. It is less likely than Levodopa to cause daytime worsening of symptoms (occurs in about 25% of patients). However, it is not recommended as the first choice in drug therapy since it causes a high rate of minor side effects. Pergolide is often used only if Levodopa has been discontinued. High potency opioids. If the symptoms of Restless Legs Syndrome are difficult to treat with the above medication, higher dose opioids will be used. These include methadone (Dolophine), oxycodone, and clonidine (Catapres, Combipres, Dixarit). A significant disadvantage of these drugs is risk of addiction. Anticonvulsants. Some cases of Restless Legs Syndrome may be improved by anticonvulsant drugs, such as carbamazepine (Tegretol). Combination therapy. Some patients respond well to combinations of drugs such as a benzodiazepine and Levodopa. Many drugs have been investigated for treatment of Restless Legs Syndrome, but it seems as though the perfect therapy has not yet been found. However, careful monitoring of side effects and good communication between patient and doctor can result in a flexible program of therapy that minimizes side effects and maximizes effectiveness. Alternative treatment It is likely that the best alternative therapy will combine both conventional and alternative approaches. Levodopa may be combined with a therapy that relieves pain, relaxes muscles, or focuses in general on the nervous system and the brain. Any such combined therapy that allows a reduction in dosage of levodopa is advantageous, since this will reduce the likelihood of unacceptable levels of drug side effects. Of course, the physician who prescribes the medication should monitor any combined therapy. Alternative methods may include: Acupuncture. Patients who also suffer from rheumatoid arthritis may especially benefit from acupuncture to relieve Restless Legs Syndrome symptoms. Acupuncture is believed to be effective in arthritis treatment and may also stimulate those parts of the brain that are involved in Restless Legs Syndrome. Homeopathy. Homeopaths believe that disorders of the nervous system are especially important because the brain controls so many other bodily functions. The remedy is tailored to the individual patient and is based on individual symptoms as well as the general symptoms of Restless Legs Syndrome. Reflexology. Reflexologists claim that the brain, head, and spine all respond to indirect massage of specific parts of the feet. Nutritional supplements. Supplementation of the diet with vitamin E, calcium, magnesium, and folic acid may be helpful for people with Restless Legs Syndrome. Some alternative methods may treat the associated condition that is suspected to cause restless legs. These include: Anemia or low ferritin levels. Chinese medicine will emphasize stimulation of the spleen as a means of improving blood circulation and vitamin absorption. Other treatments may include acupuncture and herbal therapies, such as ginseng (Panax ginseng) for anemia-related fatigue. Late-stage pregnancy. There are few conventional therapies available to pregnant women, since most of the drugs prescribed are not recommended for use during pregnancy. Pregnant women may benefit from alternative techniques that focus on body work, including yoga, reflexology, and acupuncture. |
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