Treatment and Medication for Restless Legs Syndrome.

Treatment for Restless Legs Syndrome.

Avoid food or substances that may cause or aggravate RLS symptoms. These include caffeine, alcohol or nicotine, often antihistamines and painkillers combined with antihistamines.

The sufferer can try eliminating foods containing sugar and or gluten as these may be aggravating factors. A low fat diet is often recommended, but it is important to include essential fatty acids such as Omega 3s, obtained from oily fish and for vegetarians seeds and nuts. Omega 6s and Omega 9’s are obtained from seed and Olive oils. A balance of Omega 3s, 6s and 9s is highly recommended. 

Indeed there are a number of natural ways to relieve this condition. For example increasing intake of foods containing B vitamins, folate and iron is to be recommended. This means eating more wholegrains, nuts, green leafy vegetables, citrus fruits and legumes such as dried peas and beans.  Non vegetarians can increase intake of red meat, fish and poultry. Vegetarian sources of iron include green vegetables such as leafy greens and parsley (long favoured by French women) and dark red fruits and vegetables, the most concentrated being dark red dried apricots.

Some individuals may benefit from the use of the highly sedative herb Valerian, and there are several studies to support this. Other natural sedative herbs include Hops, Skullcap and Passionflower. These have been used for centuries without negative side effects. Sufferers can add a teaspoonful of a blend of equal parts of these herbs to one cup of warm water and steep for 15 minutes. Then the tea must be strained and drunk before bed. However, most herbs these days are available as a tincture, or in tablet or capsule form and vegetarian capsules without gelatine are available. Another beneficial herb that may help RLS is St. John’s Wort traditionally used for naturally treating nervousness and depression.

Yoga and meditation as well as relaxation techniques can also be used to control RLS. A number of exercises are recommended as below.

Medication for Restless Legs Syndrome.

Drug treatment to relieve symptoms and control RLS is recommended only in cases where the sufferer is having attacks at least three times a week. It is important to realise that drugs do not in any way cure the condition and should be used only as a last resort.
The current treatment for severe or secondary (idiopathic or uraemic) RLS is Levodopa which is a dopaminergic drug. In trials investigating the effectiveness of this drug a single dose of 50 to 250 mg was administered 1 hour before bed. Results were highly encouraging as patients reported better sleep and fewer periodic limb movements (PLMS). The drug remains effective for at least two years.

The drug works well given in regular release formulations and its effects seem to last for about four hours. Also given to the patient are sustained release formulations but for greatest effectiveness these do have to be administered alongside the regular release doses, as sustained relief preparations, when given alone, tend to be insufficient. This is because Levodopa does not settle enough in the patient’s plasma before he or she is asleep. Patients who have daytime symptoms of paraesthesias and restlessness do need more medication in the day. Side effects are few and the drug is well tolerated on the whole with few Parkinsonian symptoms. Formulation and timing of doses can be altered to treat different patterns and variations of symptoms.

Other drugs which treat RLS are dopamine agonists – these include Bromocriptine ( a dopamine D2  receptor agonist) and pergolide (a combined D1 and D2    agonist) Low dosages that can be gradually increase are advised. Pramipexole is a new non-ergot dopamine agonist and is effective in improving RLS symptoms. All these dopamine agonists cannot be administered in the same way as Levodopa i.e. as needed by the patient. However, Levodopa can be combined with these drugs.
A last resort in treating RLS and PLMS is use of opioids which are effective but carry risk of dependency. Opioids include oxycodone, dextropropoxyphene napthylate and dihydrocodeine – these are short acting compounds and highly potent which also includes tilidine which can be used in combination with the opioid antagonist naloxone. Other opoids useful in treating severe disease are methadone or levorphanol tartrate or epidural morphine in extremely severe cases.

A useful class of drugs to use for severe RLS are the Benzodiazepines which were first investigated for use in the last century. Diazepam itself is not at all useful in RLS treatment. At present the most widely used  of these is Clonazepam which induces better sleep. Treatment starts at 0.5 mg daily, is gradually increased but can be as high as 4 mg. Also effective for improving sleep is Triazolam; although it does not reduce the number of PLMS occurrences it reduces related arousals.

A very last resort is the use of anticonvulsants. Carbamazapine, at daily doses of 200 to 400 mg reduces nightly RLS symptoms but not frequency of PLMS. These are less effective than opioids and dopaminergic drugs. Currently being researched is Gabapentin, which is related to GABA, as it is thought to be particularly well tolerated.

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