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Restless Leg Syndrome: It’s All in Your Head

Imagine this: It’s the end of a long day, and you’re getting sleepy. Just as you decide to head to bed, an unpleasant sensation begins in one or both of your lower legs. It might feel like a parade of tiny ants, an itch or a throb. You feel an irresistible urge to move. You’re still tired, but whenever you stop moving, the unpleasant sensation returns.

This is what restless leg syndrome (RLS) feels like, and it may afflict up to 10% of the population, leading to exhaustion,  daytime sleepiness and decreased productivity.

What Causes Restless Leg Syndrome?

Symptoms are experienced in the legs, but RLS is a neurological sensory disorder, which means the unpleasant feelings originate in the brain.

RLS can be triggered by iron deficiency and by diseases like late-stage kidney failure, multiple sclerosis or neuropathy. There’s also evidence of women developing RLS during late stages of a pregnancy, although symptoms usually diminish following delivery. In these cases, RLS is considered secondary to the main problem and will go away if the main problem is eliminated.

Much more often, RLS is the primary disease, and scientists are still working to understand what causes it. The top suspect is an imbalance of the brain chemical dopamine, which sends messages to control muscle movement. And there may be a genetic component, as restless leg syndrome often runs in families.

The good news? Although the frequency of symptoms can increase over time, RLS rarely develops into a more serious illness. And symptoms can be treated progressively. Early on, these home remedies may be adequate:

  • Avoid or decrease use of alcohol, nicotine and caffeine
  • Massage your legs
  • Take warm baths
  • Exercise moderately
  • Stretch your leg muscles
  • Apply a heating pad or ice pack

Medications for Restless Leg Syndrome

If your RLS is related to an iron deficiency, your doctor will likely put you on iron supplements. If an iron deficiency has been ruled out and medicine is called for, your doctor will work with you to select from among three categories approved by the U.S. Food and Drug Administration to treat restless leg syndrome:

  • Dopamine agonists. These drugs are effective but also carry a risk of augmenting RLS – with symptoms starting earlier in the day or occurring more frequently. Over time, higher doses may be needed. These are examples of dopamine agonists:
    • Pramipexole comes in both immediate-release and extended-release formulations – the latter for patients having symptoms even in daytime.
    • Ropinirole, which also comes in an extended-release formula.
    • Rotigotine, a patch that releases medication through the skin, directly into the bloodstream, 24 hours a day for stable, continuous treatment.
  • Anti-seizure drugs. These are effective at pain control and are frequently prescribed for people who experience pain – from neuropathy, for example – along with RLS. This category of drugs treats both symptoms. Examples are:
    • Gabapentin enacarbil
    • Pregabalin
  • Benzodiazepines. These drugs are sedatives and may help restless leg syndrome sufferers sleep more soundly, although the American Academy of Sleep Medicine says they should not be used as a first‐line treatment unless in combination with another therapy. Examples of benzodiazepines include:
    • Diazepam
    • Alprazolam
    • Clonazepam

Other Medical Considerations

Because both restless leg syndrome and Parkinson’s Disease are caused by dopamine issues, doctors sometimes put RLS patients on a Parkinson’s medication called carbidopa-levodopa. But this drug can cause quick symptom augmentation. If you are on carbidopa-levodopa and do not have Parkinson’s, work with your doctor to find an RLS-approved substitute.

Other medications that can make RLS worse include the antipsychotic drug aripiprazole and antidepressants classified as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), including sertraline, fluoxetine and amitriptyline.

If you take one of those drugs, work with your doctor to find the best combination of medicines to treat both your psychiatric and RLS symptoms.

Other Potential Treatments Studied

Research continues to expand our understanding of restless leg syndrome and other neurological disorders. That includes current studies to answer questions such as:

  • Do changes in the brain’s signaling pathways, particularly regarding the transmission of dopamine, contribute to RLS?
  • Does iron deficiency occurring any time in life cause changes in the way your genes work that could lead to RLS?
  • How does iron get into the brain through the blood-brain barrier separating circulating blood from the fluid surrounding the brain?
  • Could a wearable, non-invasive nerve stimulation device treat RLS during sleep?

As scientists learn more about what causes RLS, the future could bring additional treatments.

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