My legs felt like they had soda bubbles fizzing inside them

Managing RLS

Professor Ray ChaudhuriCommented by Prof. Ray Chaudhuri
Consultant Neurologist and Professor in Neurology, King’s College and Lewisham Hospitals, London, UK

The typical symptoms of Restless Legs Syndrome (RLS) were first described in the 17th century, but even to this day many patients suffering from RLS have still not been diagnosed correctly and, subsequently, are not being treated appropriately.2,3,4

The severity of RLS symptoms can vary from mild or intermittent to moderate to severe, and the experience of symptoms varies from patient to patient.1,3

For people with mild or intermittent RLS symptoms, medical guidelines suggest certain lifestyle changes and activities to reduce or eliminate symptoms2,5,6:

  • Mental alerting activities, such as video games or crossword puzzles can reduce symptoms at times of boredom
  • Abstinence from caffeine, nicotine, and alcohol as they can interfere with sleep
Caffeine - tea and coffee Nicotine - cigarettes and cigars Alcohol - wine, beer, ale and spirits
  • Maintaining good sleep hygiene, e.g. regular bed and rise times, exercise just before bedtime can prevent sleep
  • Avoiding sleep deprivation
  • Regular moderate exercise can help relieve the symptoms

In some cases, the patient may be advised to take supplements to correct deficiencies in iron, folate, and magnesium.

Medical treatments that improve RLS symptoms can be prescribed once secondary causes of RLS have been excluded or treated.

For the management of moderate to severe cases of RLS, there are effective and well tolerated treatments available:

  • Levodopa was the first dopaminergic agent to be studied; however, its use is limited by augmentation, which can be explained as the worsening of RLS symptoms during RLS treatment, leading to an increase in overall RLS severity compared to the period of time before treatment initiation.2,7
  • Today, dopamine agonists are considered the first–line treatment for primary RLS1 due to their clinical and statistically significant improvement in symptoms of RLS, PLMS, or both.2,3,4,8
    • Within the dopamine agonists, the non–ergot dopamine agonists such as pramipexole, ropinirole and rotigotine are generally the preferred choice for most patients due to their more favourable side effect profile.2,5 Pramipexole9 and ropinirole10 are the two non–ergot dopamine agonists currently approved and available for use in Europe and the U.S.A.

References

  1. Hening WA et al. Clinical significance of RLS. Mov Disord 2007; 22 Suppl. 18: 395-400.
  2. Muzerengi S, Lewis H, Chaudhuri KR. Restless Legs Syndrome: a review of diagnosis and management. Int J Sleep Disorders 2006; 1(2): 34-46.
  3. Holmes R et al. Nature and variants in idiopathic Restless Legs Syndrome: observations from 152 patients referred to secondary care in the UK. J Neural Transm 2007. DOI 10.1007/s00702-006-0614-3.
  4. Chaudhuri KR. The Restless Legs Syndrome: time to recognize a very common movement disorder. Practical Neurol 2003; 3: 204-213.
  5. Silber MH et al. An algorithm for the management of Restless Legs Syndrome. Mayo Clin Proc 2004; 79(7): 916–922.
  6. Chaudhuri KR. Restless Legs Syndrome. J Neurol Neurosurg Psychiatry 2001; 71: 143-146.
  7. Garcia–Borreguero D et al. Diagnostic standards for dopaminergic augmentation of Restless Legs Syndrome: Report from a world association of sleep medicine – International Restless Legs Syndrome Study Group Consensus Conference at the Max Planck Institute. Sleep Med 2007; (5): 520–530.
  8. Earley CJ. Clinical practice: Restless Legs Syndrome. New Engl J Med 2003; 348(21): 2103–2109.
  9. European SPC. Available at http://www.emea.europa.eu/humandocs/PDFs/EPAR/Mirapexin/H-134-PI-en.pdf. Accessed in February 2009.
  10. European SPC. Available at: http://www.emea.europa.eu/pdfs/human/referral/adartrel/Adartrel-Annex%20I-IV-en.pdf. Accessed in February 2009.
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