Restless legs syndrome (RLS) is a common, poorly understood movement disorder that can cause significant sleep disruption. RLS is characterized by uncomfortable sensations deep in the legs, relieved only by voluntary movement. We report a rare case of RLS associated with .
   Restless legs syndromeis an intolerable internal feeling of itching or creeping sensations in the legs that forces the affected person to move his or her legs to get relief. It usually occurs at the end of the day in bed or when seated. Restless legs syndrome occurs more often in people who suffer migraines than in those free of these headaches.
   Restless legs syndrome (RLS) is a common disorder affecting more than 2% of adults. Stop smoking and drinking. Exercise helps. Perhaps massage, warm or cold baths.

Restless leg syndrome symptoms
RLS is characterized by sensory-motor phenomena predominantly in the legs, but other body parts may be involved. The symptoms are most pronounced during rest and present a characteristic diurnal variation with maximum symptoms in the evening and at night.
   Restless leg syndrome symptoms may be induced or exacerbated by medications such as TCAs, SSRIs, lithium, and dopamine antagonists (neuroliptics, metoclopramide), H2 blockers. Caffeine also has been implicated in the worsening of restless leg syndrome symptoms-- reduce or eliminate coffee, tea, cola beverages, cocoa.
   The severity of restless leg syndrome symptoms in older adults affects not only sleep quality but also many aspects of quality of life, including social functioning, daily functioning, and emotional well-being.

Restless leg syndrome cause
Differential diagnosis includes peripheral neuropathy, leg cramps, and akathesia. Although RLS is familial in 50% of cases, secondary etiologies can be medically important. Secondary causes include iron deficiency, neurologic lesions, pregnancy (estrogen excess?) diabetes, hyperparathyroidism and uremia. Patients with newly diagnosed restless leg syndrome or recent exacerbation of symptoms should have serum ferritin levels measured. Other possible causes include fibromyalgia, thyroid disease, B12 methylcobalamin deficiency, varicose veins.

Natural treatment review
Q. I am interested in taking mucuna pruriens for restless leg syndrome. I have been diagnosed with a variant type of RLS where I don't have the jerking or spasms, but burning, pain and cold when sitting, but fine when I am moving. I understand that dopamine class drugs are often used for RLS and because I would like to try and stay away from pharmaceuticals, I am interested in the dopamine actions of mucuna pruriens, since I have come across various blogs where persons having RLS have been helped by taking mucuna pruriens. My question is to its efficacy since some people have written that the drug can not pass the blood brain barrier and therefore would not be of any use. What are your thoughts on this?
    A. We have had reports of some people benefiting from the use of this herb for their symptoms. It is difficult to predict one's response without trying the supplement.

RLS and pregnancy
Estrogen plays an important role in triggering restless legs syndrome (RLS) during pregnancy. Sleep, February 1, 2009. RLS in pregnant women goes along with transiently increased estradiol levels and periodic leg movement indices suggesting that estrogens play a role for triggering RLS symptoms during pregnancy.

Diagnosis of RLS
The physical examination is usually normal and is performed to identify secondary causes and to rule out other disorders. A neurologic examination with emphasis on spinal cord and peripheral nerve function. A vascular examination to rule out vascular disorders. Do SMA, CBC, ferritin, and TSH.

Treatment of restless legs syndrome
The first choice treatment options for restless legs syndrome are dopaminergic drugs, second choice are gabapentin or oxycodone, and the third choice are clonazepam or slow release valproic acid.

The following drugs are considered efficacious for the treatment of restless legs syndrome: levodopa, ropinirole, pramipexole, cabergoline, pergolide, and gabapentin. Drugs considered likely efficacious are rotigotine, bromocriptine, oxycodone, carbamazepine, valproic acid, and clonidine. Magnesium, folic acid, and exercise are considered to be investigational. Oral iron is potentially helpful but depends on the iron status of subjects. Cabergoline and pergolide (and possibly lisuride) require special monitoring due to fibrotic complications including cardiac valvulopathy. Special monitoring is required for several other medications based on clinical concerns: opioids (including, but not limited to, oxycodone, methadone and tramadol), due to possible addiction and respiratory depression, and some anticonvulsants (particularly, carbamazepine and valproic acid), due to systemic toxicities.

Lyrica
The anti-seizure drug pregabalin Lyrica appears to help patients with restless legs syndrome get a better night's sleep. Pregabalin, which is approved for the treatment epilepsy, neuropathic pain, generalized anxiety and fibromyalgia, was well tolerated by patients with restless legs syndrome and is a promising alternative to current treatments because of its superior effects on quality of sleep. Dr. Diego Garcia-Borreguero, director of the Sleep Research Institute in Madrid, Spain, tested 58 patients with restless legs syndrome of unknown origin. After 2 weeks on a placebo, 30 patients were assigned to receive pregabalin (150 to 600 milligrams daily) and 28 remained on the placebo for 12 weeks. According to Dr. Diego Garcia-Borreguero, the change in International Restless Legs Syndrome Rating Scale scores was significantly "more pronounced" with pregabalin than with placebo. With pregabalin, scores on this disease severity index declined from 19 to 6\; with placebo, scores declined from 21 to 11.

Rotigotine skin patches may be effective for restless legs syndrome
Use of skin patches containing the drug rotigotine may relieve restless legs syndrome during both the day and night. Recent studies on the genetic basis of restless legs syndrome have suggested that this condition needs to be treated as a general neurological disorder. Dopamine increasing drugs are currently used as the first-line treatment for this condition. Rotigotine is a dopamine increasing drug that is already used for treating Parkinson's disease. Claudia Trenkwalder, MD, Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany, and colleagues performed a randomised, controlled trial to investigate the efficacy of transdermal rotigotine patches in the treatment of restless legs syndrome. The trial analysed 458 patients with moderate to severe restless legs syndrome. The patients were randomly assigned to receive transdermal rotigotine 1 mg, 2 mg, 3 mg, or placebo over 24 hours. The medication was delivered via patches, applied once a day for 6 months. The results of this 6-month trial indicate that transdermal delivery of low doses of rotigotine for 24 hours per day are more effective than placebo in relieving the symptoms of restless legs syndrome in patients who are moderately to severely affected. There exists a clear therapeutic window in terms of dose of rotigotine to treat restless legs syndrome between 1 mg over 24 hours to 3 mg over 24 hours. July 2008 edition of The Lancet Neurology.

Treatment with vitamin B complex significantly reduced the frequency, intensity, and duration of nocturnal leg cramps.

Pharmacologic treatment of restless leg syndrome includes dopaminergic agents, opioids, benzodiazepines and anticonvulsants.

Dopamine precursor combinations such as carbidopa-levodopa can be used on a "one-time" basis or as circumstances may require. Useful for persons with intermittent RLS because dopamine agonists take longer to have an effect. Therapeutic effect may be reduced if taken with high-protein food. Can cause insomnia, sleepiness and gastrointestinal problems. Dose is half of a 25/100 mg carbidopa/levodopa pill at dinner or bedtime.

Dopamine agonists such as pergolide 0.05 mg, bromocriptine 1.25 mg, pramipexole 0.125 mg, ropinirole 0.25 mg Useful in moderate to severe RLS. Recent reports indicate high efficacy of dopamine agonists, but the role of their long-term use is unknown. Can cause severe sleepiness, which may limit its use during daytime. Agonists can cause nausea. To avoid this, slow dosage increase is important, especially for pergolide.

Restless legs syndrome associated with increased mortality
Both restless leg syndrome and periodic limb movement in sleep cause chronic sleep loss and sleep fragmentation, which in turn lead to increased cardiovascular risk. Chronic sleep fragmentation is associated with an increased hypertensive burden that may result in left ventricular hypertrophy, which is an independent predictor of mortality.

Restless legs syndrome natural treatment questions
Q. I'm a 20 yr old women and have had the symptoms of restless legs syndrome since roughly age 15. My mother has it, so considering i have a healthy diet and ride a bicycle everyday, Its very severe, i can't stay still during the day, and i get hardly any sleep. i also feel the need to move my shoulders and neck, though its not as bad as the legs, i told my doctor but was just told "its very uncommon in young people, i'm not giving valium". i have no desire to take drugs, as disruptive as it is I've put up with it for five yrs so i can live with it. i'm a vegetarian, with good iron levels, i don't drink alcohol, caffeine, or softdrink. i exercise everyday. the only thing i've tryed for my legs is massage which is beneficial, but the effect only lasts a couple of days and its expensive. Is there a safe, non extreme treatment that you could suggest?
   A. We will update this page on restless legs syndrome natural treatment as more studies are published.

Q. When ever I sit down to rest, one or the other lower leg, starts to twitch every 45 seconds or so. My Doctor without doing any testing said I have restless leg syndrome and Rx Requip to supposedly replace the dopamine levels that he believes I am deficient in. The Requip usually, but not always, stops the twitching within an hours or so and then I can sleep. My question; have there been any studies to show that taking tyrosine boosts your bodies ability to produce dopamine, thereby eliminating the deficiency and potentially the twitch?
   A. We have not seen such studies. The use of tyrosine is likely to increase alertness and interfere with proper sleep.

Q. I have had severe restless leg syndrome for about 15 years ( arms and legs ). I have gone to a sleep specialist that prescribed Requip and also Gabapentin to take in the evening. My symptoms have now invaded my afternoon hours and I have had to take a 1mg tablet to relieve the symptoms to get through the work day even though it makes me very tired. My question is , has there been any studies done as to the effectiveness of acupuncture for restless leg syndrome ? My symptoms have degraded my life and activities to a degree that is becoming unbearable.
   A. Acupuncture is not something we have focused on, so we don't know.

Q. It is almost a month I am taking mucuna pruriens plus Requip for my restless leg syndrome. I was wondering if it is OK if I take with Requip.
   A. We can't make that decision for you, your doctor may wish to read more about mucuna pruriens and give you advice. It is always a good idea to learn how each herb or medicine works by itself before combining.

Q. Was reading your info on restless leg syndrome which I experience and has worsened recently. My father also suffered with this. I remember getting up in the middle of the night and making him an onion sandwich. Yes, two slices of bread , fresh onions and ketchup. I have since read that there is some sort of natural sedative in raw onions. This worked to settle his legs. I am just not a fan of raw onions so have not tried this myself.
   A. Interesting. We have not heard of this onion sandwich treatment.

Q. Three weeks ago I started taking a course of pramipexole 0.350mg daily for restless legs syndrome and this has proved to be effective. However, I discovered a few days ago that I have developed a lump in my right thyroid gland. A blood test analysis did not identify an overactive or underactive thyroid but did reveal that I have an iron deficiency ( which was not apparent in a blood test I had three months ago). I have been referred to a specialist for examination but I have no idea if there is any possible link between the course of tablets I am on and the thyroid/iron deficiency problems.

Q. I have great success for my taking sublingual folic acid 5 mg available from Intensive Nutrition. It doesn't cure, but takes the twitching away. Also Floridix iron, and B12 injections.

Q. We are uncertain how to proceed as the SAM-e is the only thing that has helped my husband's restless legs syndrome in the 40 years he has had it! He even tried taking Mirapex (which helped minimally) for 2 years and then got off it. As to the SAM-e, he got off it 2 or 3 days, and now is taking half as much (200 mg per day instead of 400 mg a day); and his restless legs syndrome is beginning to come back!. Plus his insomnia is not diminishing. 30 days later: he has increased his SAM-e back to 400 mg a day. The restless legs syndrome has improved but his insomnia is much worse. He has been using Temazapam for 2 years but it has quit working.

Q. I generally take calcium, magnesium, melatonin, all the vitamins, and homeopathic products for sleeping but does not do much for me. I don't know if I should buy 5 htp or gaba since I am already taking melatonin.

Q. My husband has had severe RLS and insomnia for 40 years. For the past year he has been using SAM-e supplement for his restless legs syndrome. He started out at 400 mg per day, then after a few months reduced it to 200 mg per day. Amazingly, it has helped a lot with his restless legs syndrome! However, his insomnia, which we had attributed to his RLS, has continued; even worsened. I had asked 2 pharmacists if SAM-e could cause insomnia and they both emphatically said no. But I still was not satisfied as I felt if something was an anti-depressant, it might "rev" a person up and might cause insomnia as a side effect. Then I read one of your articles re one of the possible side effects of SAM-e supplement and found it was insomnia! And further, that SAM-e taken over a long period of time can be accumulative. Apparently the pharmacists were not aware of this! Anyhow, my husband has cut back gradually on the SAM-e tablets until recently quit it. And now his RLS has flared back up.

index yohimbe bark home