How is restless legs syndrome (RLS) treated?

HealthyWomen
Administration
Some people find that activities such as taking a hot bath, massaging their legs, using a heating pad or ice pack, exercising and eliminating caffeine help relieve symptoms of restless legs syndrome (RLS). In more severe cases, medications may be prescribed.

Doctors may suggest a variety of drugs to treat RLS. Ropinirole (Requip) and pramipexole (Mirapex) are approved by the U.S. Food and Drug Administration (FDA) to treat moderate to severe RLS. These drugs are in a class of medications known as dopamine agonists and were first approved for the treatment of Parkinson's disease. Another dopamine agonist, rotigotine (Neupro), has also been approved for the treatment of RLS. Rotigotine is unique because it is worn as a transdermal patch and the medication is absorbed through the skin.

Beyond these, there are four types of medications used to treat RLS. Benzodiazepines and benzodiazepine receptor agonists are central nervous system depressants that allow you to get more sleep but don't fully suppress RLS sensations or leg movements. The most commonly prescribed benzodiazepine for RLS is clonazepam (Klonopin); eszopiclone (Lunesta), zolpidem (Ambien) and zaleplon (Sonata) are considered benzodiazepine receptor agonists. The most common side effects of these medications are residual daytime drowsiness and short-term memory impairment.

Opioid analgesics, such as the combination of oxycodone and acetaminophen (Percocet) and codeine are pain-relieving medications that can also suppress RLS and periodic limb movement disorder (PLMD). Side effects include dizziness, nausea, vomiting, constipation and the risk of addiction.

Anticonvulsant drugs such as gabapentin (Neurontin) and gabapentin enacarbil (Horizant) may also help reduce the sensory disturbances associated with RLS. Those sensations include pulling, itching, tingling, burning or aching -- sometimes described as creeping and crawling. Dizziness, fatigue and sleepiness are among the possible side effects.

Other Parkinson's disease medications, including a combination of carbidopa and levodopa (Sinemet), reduce the uncomfortable sensations in your legs by affecting levels of the chemical dopamine in your brain. People who have RLS are not at an increased risk of developing Parkinson's disease, however.
Treatment of restless leg syndrome is based upon severity and frequency of symptoms. In people with mild, occasional symptoms, treatment is largely based on behavioral changes and lifestyle modification. Sleep hygiene is often recommended and consists of achieving a consistent, uninterrupted sleep schedule and avoiding caffeine, alcohol or nicotine. Other measures that may help include increased exercise or taking a hot or cold bath before going to bed. In people who have more severe symptoms, there are several different medications that can be used in an attempt to control symptoms. The decision to start medication should be a mutual decision between you and your doctor, who can then help you decide which medication would be best to start.
While there is no cure for restless legs syndrome, several treatment options may help relieve symptoms. In many cases, if an underlying condition is found, such as anemia, treating that condition can help get rid of symptoms of RLS. Limiting caffeine or taking iron supplements may help, too. Certain medications may also be effective.

Although movement brings relief to those with restless legs syndrome (RLS), it is generally only temporary. However, RLS can be controlled by finding any possible underlying disorder. Often, treating the associated medical condition, such as peripheral neuropathy or diabetes, will alleviate many symptoms. For patients with idiopathic RLS, treatment is directed toward relieving symptoms.

Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Studies also have shown that maintaining a regular sleep pattern can reduce symptoms. Some individuals on finding that RLS symptoms are minimized in the early morning change their sleep patterns. Others have found that a program of regular moderate exercise helps them sleep better; on the other hand, excessive exercise has been reported by some patients to aggravate the symptoms of RLS. Taking a hot bath, massaging the legs, or using a heating pad or an ice pack can help relieve symptoms in some patients. Although many patients find some relief with such measures, rarely do these efforts completely eliminate symptoms.

Physicians also may suggest a variety of medications to treat RLS. Generally, physicians choose from dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. Dopaminergic agents, largely used to treat Parkinson's disease, have been shown to reduce RLS symptoms and periodic limb movement disorder (PLMD) and are considered the initial treatment of choice. Good short-term results of treatment with levodopa and carbidopa have been reported, although most patients eventually will develop augmentation, meaning that symptoms are reduced at night but begin to develop earlier in the day than usual. Dopamine agonists such as pramipexole and ropinirole hydrochloride may be effective in some patients and are less likely to cause augmentation.

Anticonvulsants such as carbamazepine and gabapentin are also useful for some patients because these decrease sensory disturbances (creeping and crawling sensations). Dizziness, fatigue, and sleepiness are among the possible side effects.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
Restless legs syndrome is a neurologic problem that prevents the nerves and muscles from talking together clearly. Learn about some ways to alleviate restless leg syndrome in this video with Dr. Oz.

 

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