Restless Legs Syndrome (RLS) Treatment

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Restless legs syndrome (RLS) is a serious, but treatable condition. The key to living with RLS is managing the symptoms. Lifestyle changes, like limiting caffeine and alcohol, taking iron supplements or a hot bath, or initiating an exercise plan, and seeing a heath care professional to discuss treatment options can help. Everyone experiences RLS differently, so it is important to work with your health care professional to determine the best way for you to control your symptoms. A detailed list of some other lifestyle changes you and your health care professional may want to consider include:

  • Checking to see if there is an underlying iron or vitamin deficiency and then possibly supplementing your diet with iron, vitamin B12 or folate.
  • Looking at medications you may be taking which could make RLS symptoms worse. These may include drugs used to treat high blood pressure, heart conditions, nausea, colds, allergies, and depression.
  • Looking at any herbal and over-the-counter medicines you may be taking to see if they could be worsening your RLS.
  • Identifying habits and activities that worsen RLS symptoms.
  • Looking at your diet to assure it is healthy and balanced.
  • Eliminating or lessening your alcohol intake.
  • Looking at various activities that may help you personally deal with RLS.
    • These could include walking, stretching, taking a hot or cold bath, massage, acupressure, or relaxation techniques.
    • Also keeping your mind engaged with activities like discussions, needlework or video games when you have to stay seated.
    • Implementing a program of good sleep habits.
    • Reducing or eliminating caffeine from your diet to aid in general sleep hygiene.

Drugs Approved to Treat RLS

  • Horizant® (gabapentin enacarbil) was approved by the FDA in 2011 for the treatment of moderate-to-severe primary RLS.
  • Mirapex® was approved by the FDA in 2006 for the treatment of moderate-to-severe primary RLS.
  • Requip® (ropinirole hydrochloride), a drug commonly used to treat Parkinson disease, was given FDA approval at lower doses for the treatment of moderate-to-severe primary RLS in 2005.

All three drugs may cause side effects, such as sedation, nausea and dizziness and may cause patients to fall asleep without any warning, even while doing normal daily activities such as driving.

In addition to Horizant®, Requip®, and Mirapex®, there are several drugs approved for other conditions that have been shown to alleviate RLS symptoms. They are:

  • Dopaminergic agonists -- reduce RLS symptoms
  • Dopaminergic agents -- reduce RLS symptoms
  • Benzodiazepines -- allow for a more restful sleep
  • Opiates -- induce relaxation and diminish pain

Side Effects of RLS Drugs

Side effects of RLS drug therapy may include daytime sleepiness (dopaminergic agonists and benzodiazepines), hallucinations and nausea (dopaminergic agents) or constipation and dependency (opiates). Before taking any medication, discuss the possibility of side effects with your doctor.

In 1996, Drs. Allen and Earley from Johns Hopkins University described a phenomenon called augmentation, in which RLS symptoms are more severe, spread to parts of the body other than the legs, and begin earlier in the evening as a result of taking dopaminergic agents to treat RLS symptoms. If augmentation occurs it can be managed with dose and medication adjustments.

Home Treatment of RLS

There are also a number of self-directed activities for managing the symptoms of RLS including walking, massaging the legs, stretching, hot or cold packs, vibration, and acupressure. Practicing relaxation techniques such as meditation or yoga have been known to alleviate symptoms. For many people, treating an underlying cause or effective pharmacological treatment of primary RLS and implementation of coping strategies provides relief from most symptoms. However, sometimes medications need to be changed over time or doses adjusted and regular consultation with a physician is recommended.